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Individual

MATTHEW JOHN RUSSO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.S., CCC-A

Contact information

Practice address
7 ESSEX GREEN DR, SUITE 2, PEABODY, MA 01960-2961
(978) 532-6650
Mailing address
PO BOX 406153, ATLANTA, GA 30384-1876
(978) 532-6650

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
777
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
5104378
MA
Enumeration date
06/30/2006
Last updated
01/14/2009
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