Individual
MARK B RUSSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
135 COLLEGE ST, THIRD FLOOR, NEW HAVEN, CT 06510-2483
(203) 785-4197
(203) 785-7391
Mailing address
135 COLLEGE ST, THIRD FLOOR, NEW HAVEN, CT 06510-2483
(203) 785-4197
(203) 785-7391
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
032596
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001325960
—
CT
Enumeration date
11/14/2005
Last updated
04/01/2011
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