Individual
DR. KATHLEEN F RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
129 WOODSON ST, SALISBURY, NC 28144-3255
(704) 636-5576
(704) 636-1755
Mailing address
129 WOODSON ST, SALISBURY, NC 28144-3255
(704) 636-5576
(704) 636-1755
Taxonomy
Speciality
Code
Description
License number
State
207NP0225X
Pediatric Dermatology Physician
9700384
NC
208000000X
Pediatrics Physician
9700384
NC
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
9700384
NC
2080C0008X
Child Abuse Pediatrics Physician
9700384
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1032H
BCBS
NC
01
—
1241179
UNITED HEALTHCARE
NC
01
—
20522
PARTNERS
NC
01
—
284339
MAMSI
NC
01
—
413263
PHCS
NC
01
—
560988747
CIGNA HEALTHCARE
NC
01
—
72589
MEDCOST PREFERRED
NC
01
—
8382976
AETNA
NC
05
—
891032H
—
NC
Enumeration date
09/27/2006
Last updated
07/11/2013
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