Individual
MR. JOHN ALBERT RUSSELL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1104 HEALTHWAY DR, SALISBURY, MD 21804-4469
(410) 219-5483
(410) 219-5486
Mailing address
PO BOX 1978, SALISBURY, MD 21802-1978
(410) 749-1015
(410) 749-0654
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140897600
—
MD
05
—
140897602
—
MD
Enumeration date
05/25/2021
Last updated
05/25/2021
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