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Individual
MICHAEL J RUSSO
Active
Individual
MICHAEL J RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001911
CT
363A00000X
Physician Assistant
Primary
031904-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003019114
—
CT
Enumeration date
06/29/2007
Last updated
07/02/2024
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