Individual
BERTRAM ROYCE RUSSELL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 E MARSHALL ST, WEST CHESTER, PA 19380-4412
(610) 431-5132
(610) 363-9892
Mailing address
416 YOUNGSFORD LN, GLADWYNE, PA 19035-1609
(610) 658-2244
(610) 658-2403
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD020168E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000741496
—
PA
Enumeration date
07/20/2006
Last updated
12/10/2008
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