Individual
MATTHEW RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
926 COPPER STONE CIR, CHESAPEAKE, VA 23320-8268
(757) 724-8813
Mailing address
926 COPPER STONE CIR, CHESAPEAKE, VA 23320-8268
(757) 724-8813
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Enumeration date
04/28/2021
Last updated
04/28/2021
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