Individual
AMANDA J RUSSELL-KLEINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
LEE ST, CHARLOTTESVILLE, VA 22908-0001
(434) 924-5725
(434) 924-1138
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
FR3024130
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/09/2008
Last updated
02/02/2012
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