Individual
DR. RUSSELL D DONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
94 SOUTH ST, SOUTHBRIDGE, MA 01550-4000
(508) 764-2772
(508) 764-2833
Mailing address
PO BOX 40, SOUTHBRIDGE, MA 01550-0040
(508) 909-7799
(508) 764-2432
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
56088
MA
207X00000X
Orthopaedic Surgery Physician
LT-3003
NH
207X00000X
Orthopaedic Surgery Physician
MD19308
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780672105
—
ME
Enumeration date
10/10/2005
Last updated
12/18/2020
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