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Individual

MADELINE RUSSELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-3040
(215) 707-8235
Mailing address
3509 N BROAD ST, PHILADELPHIA, PA 19140-4105
(215) 707-9211

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
17833
GA
2084N0400X
Neurology Physician
Primary
MD4943880
PA
2084N0400X
Neurology Physician
MT222711
PA

Other

Enumeration date
04/07/2021
Last updated
04/16/2026
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