Organization
SPECIALISTS IN PLASTIC SURGERY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER B RUSSELL MD (PRESIDENT)
(919) 785-0505
Entity
Organization
Contact information
Practice address
3633 HARDEN RD, STE 200, RALEIGH, NC 27607-3369
(919) 785-0505
(919) 785-0205
Mailing address
3633 HARDEN RD, STE 200, RALEIGH, NC 27607-3369
(919) 785-0505
(919) 785-0205
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011EM
BCBS
NC
05
—
89011EM
—
NC
Enumeration date
07/27/2005
Last updated
02/27/2008
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