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Individual
STEVEN CHRISTOPHER RUSSO
Active
Individual
STEVEN CHRISTOPHER RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-07102
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720266364
—
NC
05
—
3725PA
—
SC
Enumeration date
02/06/2008
Last updated
12/22/2021
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