Individual
MARK WILLIAM RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1126 N CHURCH ST, STE 201, GREENSBORO, NC 27401-1000
(336) 235-0866
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
9500209
NC
207RG0100X
Gastroenterology Physician
9500209
NC
207RT0003X
Transplant Hepatology Physician
Primary
9500209
NC
Other
Enumeration date
10/18/2006
Last updated
07/15/2024
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