Individual
ROBERT D. RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
75 KINGS HIGHWAY CUTOFF, SUITE 1A, FAIRFIELD, CT 06824-5340
(203) 815-1877
(203) 538-5246
Mailing address
4695 MAIN ST, SUITE 5, BRIDGEPORT, CT 06606-1802
(203) 538-5233
(203) 538-5246
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
016805
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001168053
—
CT
Enumeration date
06/30/2005
Last updated
03/07/2017
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