Individual
DR. DAVID THOMAS RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
121 N TULPEHOCKEN ST, PINE GROVE, PA 17963-1217
(570) 345-2345
Mailing address
PO BOX 783311, PHILADELPHIA, PA 19178-3311
(484) 884-4500
(484) 884-0699
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OS019805
PA
Other
Enumeration date
04/04/2016
Last updated
08/23/2019
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