Individual
MRS. CORRINE M RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8860 COLUMBIA 100 PKWY STE 400, COLUMBIA, MD 21045
(410) 964-8346
(410) 964-4412
Mailing address
3700 COLLEGE AVE APT 402, ELLICOTT CITY, MD 21043-4641
(410) 294-7246
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/30/2017
Last updated
07/09/2018
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