Individual
J C TRUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
750 EAST ADAMS STREET, UPSTATE UNIVERSITY HOSPITAL, SYRACUSE, NY 13210
(315) 464-6031
(315) 464-6117
Mailing address
750 EAST ADAMS STREET, UPSTATE UNIVERSITY HOSPITAL, SYRACUSE, NY 13210
(315) 464-6031
(315) 464-6117
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
253896
NY
208800000X
Urology Physician
MD418317
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018902490001
—
PA
05
—
03124494
—
NY
Enumeration date
04/25/2006
Last updated
10/21/2010
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