Individual
DR. GEORGE H RUSSELL
Active
Individual
DR. GEORGE H RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
213288
MA
2080P0206X
Pediatric Gastroenterology Physician
213288
MA
2080P0206X
Pediatric Gastroenterology Physician
Primary
MD20882
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0192830
—
MA
01
—
460383
TUFTS HEALTH PLAN
MA
01
—
J24704
BCBS MA
MA
Enumeration date
11/08/2005
Last updated
08/18/2016
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