Individual
RUSSELL S ELWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
158 E MAIN ST, WESTFIELD, NY 14787-1155
(716) 326-4686
(716) 326-4628
Mailing address
158 E MAIN ST, WESTFIELD, NY 14787-1155
(716) 326-4686
(716) 326-4628
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
115079-1
NY
208D00000X
General Practice Physician
Primary
115079
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010200001
UNIVERA
NY
01
—
000507267001
BLUE CROSS/SHIELD WNY
NY
05
—
00607790
—
NY
01
—
1702196
INDEPENDENT HEALTH
NY
Enumeration date
07/01/2006
Last updated
09/30/2020
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