Individual
MR. RUSSELL MEMHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
600 NORTHERN BLVD, ALBANY, NY 12204-1004
(518) 471-3272
Mailing address
PO BOX 14890, ALBANY, NY 12212-4890
(518) 525-5634
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
004263-1
NY
Other
Enumeration date
03/08/2007
Last updated
06/11/2021
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