Individual
DR. RUSSELL CLAY AULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
3401 CIVIC CENTER BLVD, DIVISION OF GENERAL PEDIATRICS, PHILADELPHIA, PA 19104-4319
(215) 590-1220
Mailing address
3401 CIVIC CENTER BLVD, DIVISION OF GENERAL PEDIATRICS, PHILADELPHIA, PA 19104-4319
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MT225185
PA
Other
Enumeration date
05/26/2022
Last updated
05/26/2022
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