Individual
DR. GARY J RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, YAW 6, BOSTON, MA 02114-2621
(617) 726-8705
(617) 724-2710
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 726-8705
(617) 724-2710
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
57051
MA
2080P0206X
Pediatric Gastroenterology Physician
Primary
57051
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057051
TUFTS HEALTH PLAN
MA
05
—
3036430
—
MA
01
—
J07673
BCBS MA
MA
Enumeration date
10/31/2005
Last updated
08/01/2012
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