Individual
RUSSELL S BUFALINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.,J.D.
Contact information
Practice address
313 S MAIN ST, OLD FORGE, PA 18518-1606
(570) 451-1122
(570) 451-0541
Mailing address
313 S MAIN ST, OLD FORGE, PA 18518-1606
(570) 451-1122
(570) 451-0541
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
MD008940E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1563559
—
PA
01
—
7289228
AETNA
PA
01
—
817264
1ST PRIORITY
PA
01
—
BU108435
BLUE CROSS BLUE SHIELD
PA
Enumeration date
03/23/2006
Last updated
03/18/2010
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