Individual
DR. MARY LOUISE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1405 SHADY AVE, PITTSBURGH, PA 15217-1350
(412) 420-2270
(412) 420-4450
Mailing address
1 MEDICAL CENTER DR, P.O.BOX 9196, MORGANTOWN, WV 26506-1200
(304) 293-3909
(304) 293-7042
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD044119E
PA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
29378
WV
208100000X
Physical Medicine & Rehabilitation Physician
MD044119E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1170159
—
PA
Enumeration date
03/08/2006
Last updated
04/12/2022
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