Individual
DR. CHARLES E RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2611 WAYNE AVE, DAYTON, OH 45420-1833
(937) 256-7801
(937) 641-8517
Mailing address
3195 DAYTON XENIA RD # 900-162, BEAVERCREEK, OH 45434-6390
(937) 718-7677
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
35050063
OH
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
35050063
OH
208D00000X
General Practice Physician
35050063
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000546225
ANTHEM
OH
05
—
0573348
—
OH
Enumeration date
10/25/2005
Last updated
02/09/2026
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