Individual
ANNA RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
56 FRANKLIN ST, WATERBURY, CT 06706-1253
(203) 709-6000
Mailing address
110 LAWNWOOD AVE, LONGMEADOW, MA 01106-3021
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
PA5541
MA
Other
Enumeration date
08/04/2015
Last updated
01/10/2025
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