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Individual

JOHN F RUSSO

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
700 E NORWEGIAN ST, POTTSVILLE, PA 17901-2710
(570) 621-4188
Mailing address
11 LOWELL DR, READING, PA 19606-9559
(610) 689-9066

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD012488E
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0007815440003
PA
Enumeration date
08/23/2005
Last updated
07/09/2007
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