Individual
DR. CHRISTOPHER JOHN RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1345 FARMINGTON AVE, BRISTOL, CT 06010-4776
(860) 585-0000
(860) 584-5514
Mailing address
1345 FARMINGTON AVE, BRISTOL, CT 06010-4776
(860) 585-0000
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
053760
CT
207W00000X
Ophthalmology Physician
14895
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1017993
—
VT
01
—
1639372345
ANTHEM
—
05
—
30209796
—
NH
01
—
8705025
CIGNA
—
01
—
9507532
AETNA
—
01
—
AA183908
HARVARD PILGRIM
—
Enumeration date
06/08/2007
Last updated
02/22/2023
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