Individual
MATTHEW L. RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 CENTRE STREET, DEPARTMENT OF MEDICINE, ROSLINDALE, MA 02131
(617) 363-8849
(617) 363-8929
Mailing address
1200 CENTRE STREET, DEPARTMENT OF MEDICINE, ROSLINDALE, MA 02131
(617) 363-8849
(617) 363-8929
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
207327
MA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
207327
MA
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
207327
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10033265A
—
MA
01
—
S400169483
MEDICARE PTAN
MA
Enumeration date
05/04/2006
Last updated
09/29/2015
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