Individual
RUSSL ALTABTABAEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-5500
(508) 334-3408
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
59.000894
OH
213E00000X
Podiatrist
Primary
PDF2560
MA
213ES0131X
Foot Surgery Podiatrist
PDF2560
MA
Other
Enumeration date
05/26/2021
Last updated
09/05/2024
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