Individual
ANTHONY P RUSSO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
807 W MAIN ST, WILMINGTON, OH 45177-0868
(937) 382-1864
(937) 382-8917
Mailing address
6605 ABERCORN ST, SUITE 108, SAVANNAH, GA 31405-5815
(912) 355-7214
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
34007741R
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000238391
ANTHEM
OH
05
—
0589411
—
OH
Enumeration date
02/06/2007
Last updated
03/04/2013
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