Russell David Mader, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD0000030476 Issued in TN

Practice address

2300 W Stone Dr
Kingsport, TN 37660-2360

Phone

(423) 246-4961

Fax

(423) 245-3136

NPI assigned

Jan 6, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193184000000",
    "number": "1871571182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 W STONE DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376602360",
            "telephone_number": "423-246-4961",
            "fax_number": "423-245-3136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 W STONE DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376602360",
            "telephone_number": "423-246-4961",
            "fax_number": "423-245-3136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADER",
        "first_name": "RUSSELL",
        "middle_name": "DAVID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-06",
        "last_updated": "2007-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TN",
            "license": "MD0000030476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie M Macdonald, DPT
• John M Machen, DDS
• Jessica Mack-Gill, MD, MS
• Leslie Trivett Maclucas, APRN
• Whitney Leigh Maden, FNP
• Shailee A Madhok, M.D.
• Hannah M Madill, NP
• Madison Operating Group LLC (Madison House)
• Patricia Madison, CRNA
• Michael Allen Magee, M.D.

• Dermatology Physician in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Dermatology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.