Individual
DR. L. RUSSELL PET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4 HARTWELL ST STE 1, FALL RIVER, MA 02721-3019
(508) 675-0089
(508) 675-2233
Mailing address
4 HARTWELL ST, FALL RIVER, MA 02721-3019
(508) 675-0089
(508) 675-2233
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
150723
MA
2084P0800X
Psychiatry Physician
8850
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3154564
—
MA
Enumeration date
07/20/2006
Last updated
04/23/2020
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