Individual
CARLY RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
107 GAMMA DR STE 210, PITTSBURGH, PA 15238-2936
(412) 963-6677
Mailing address
520 JEFFERSON AVE, JEANNETTE, PA 15644-2538
(724) 527-8060
(724) 522-4002
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA054790
PA
Other
Enumeration date
03/15/2011
Last updated
01/13/2017
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