Individual
DR. JOSEPH A RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
575 BOYLSTON ST, SUITE 2, NEWTON CENTRE, MA 02459-2740
(617) 964-1440
(617) 964-7833
Mailing address
575 BOYLSTON ST, SUITE 2, NEWTON CENTRE, MA 02459-2740
(617) 964-1440
(617) 964-7833
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
80064
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J09148
BLUE CROSS BLUE SHIELD
MA
Enumeration date
03/01/2006
Last updated
07/08/2007
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