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Individual

MARY C. RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
301 MEDICAL PARK DR, STE 202B, CONCORD, NC 28025-2981
(704) 403-2626
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2010-00892
NC
2080P0006X
Developmental - Behavioral Pediatrics Physician
2010-00892
NC

Other

Enumeration date
02/17/2006
Last updated
07/15/2024
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