Individual
ERICH RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
33 SEWALL ST, PORTLAND, ME 04102-2603
(207) 828-2100
Mailing address
324 GANNETT DR STE 200, SOUTH PORTLAND, ME 04106-3266
(207) 482-7800
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
OS15702
FL
2085R0204X
Vascular & Interventional Radiology Physician
Primary
DO3056
ME
2085R0204X
Vascular & Interventional Radiology Physician
OS15702
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255743605
—
ME
Enumeration date
05/20/2014
Last updated
07/07/2020
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