Individual
MS. MAIRA ANABEL RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3 COOPER PLZ, CAMDEN, NJ 08103-1438
(856) 342-2439
Mailing address
1 FEDERAL ST # 200, CAMDEN, NJ 08103-1088
(856) 356-4924
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00258900
NJ
Other
Enumeration date
08/16/2011
Last updated
03/07/2018
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