Edward Rose Russell, MD
Individual provider Active NPI Contractor · Rose Valley, PA
NPI 1871831271 · NPPES record last updated Jan 21, 2013
Key facts
- NPI
- 1871831271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- MD014589E (PA)
- Practice address
- 5 Orchard LN
Rose Valley, PA 19086-6707 - Phone
- (610) 566-6804
- NPI assigned
- Jan 21, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD014589E | PA | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | MD014589E | PA | Yes |
Addresses
Primary practice location
5 Orchard LN
Rose Valley, PA 19086-6707
Mailing address
5 Orchard LN
Rose Valley, PA 19086-6707
Phone (610) 566-6804
Other providers in Rose Valley, PA
- Ali Koohdary
- John F McCormick
- Sarah E. Mutter
- Neuropath Speech Therapy, LLC
- Carol Bruno Rude
- Jane Marie Stopford
All providers in Rose Valley, PA · Contractor in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.