Individual
ANDREA M RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 COOPER PLZ, 3 DORRANCE, CAMDEN, NJ 08103-1461
(856) 342-2604
(856) 968-8282
Mailing address
1 COOPER PLZ, 4TH FLOOR CATH LAB, CAMDEN, NJ 08103-1461
(856) 342-2625
(856) 968-8431
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD037999E
PA
207RC0000X
Cardiovascular Disease Physician
Primary
MD037999E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016796250001
—
PA
Enumeration date
07/07/2006
Last updated
04/25/2016
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