Individual
MR. CHARLES DAMIN RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4725 N FEDERAL HWY, SUITE 401, FORT LAUDERDALE, FL 33308
(954) 772-2136
(954) 772-7156
Mailing address
4725 N FEDERAL HWY, SUITE 401, FORT LAUDERDALE, FL 33308
(954) 772-2136
(954) 772-7156
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME0046573
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D02884498
CLIA
FL
Enumeration date
03/14/2006
Last updated
03/07/2023
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