Organization
STEPHANIE F RUSSO MD PEDIATRICS P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM G WICKHAM JR. (PRACTICE ADMINISTRATOR)
(814) 838-3480
Entity
Organization
Contact information
Practice address
3910 CAUGHEY RD, SUITE 170, ERIE, PA 16506-4096
(814) 838-3480
(814) 838-3489
Mailing address
3910 CAUGHEY RD, SUITE 170, ERIE, PA 16506-4041
(814) 838-3480
(814) 838-3489
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD043940L
PA
Other
Enumeration date
06/16/2006
Last updated
08/22/2020
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