Individual
GREGORY D. RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
49 STATE RD, NORTH DARTMOUTH, MA 02747-3322
(508) 973-6650
(508) 973-0345
Mailing address
200 MILL RD, SUITE 180, FAIRHAVEN, MA 02719-5252
(508) 973-2000
(508) 973-2002
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
150866
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110059962A
—
MA
Enumeration date
05/22/2006
Last updated
04/24/2020
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