Individual
MANUEL ANTONIO GARCIA RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 N BROAD ST STE 400, PHILADELPHIA, PA 19140-5103
(215) 707-3133
Mailing address
2229 S DARIEN ST, PHILADELPHIA, PA 19148-3105
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MT230753
PA
Other
Enumeration date
05/17/2024
Last updated
05/17/2024
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