Individual
JONATHAN MATT RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
47 OBERY ST, SUITE 201, PLYMOUTH, MA 02360-2229
(508) 747-1560
(508) 747-5155
Mailing address
47 OBERY ST, SUITE 201, PLYMOUTH, MA 02360
(508) 747-1560
(508) 747-5155
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
49964
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3020835
—
MA
Enumeration date
04/27/2006
Last updated
08/25/2016
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