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Individual
RUSSELL MARCUS
Active
Individual
RUSSELL MARCUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2101
SC
363AM0700X
Medical Physician Assistant
2101
SC
Other
Enumeration date
04/15/2014
Last updated
04/09/2020
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