Individual
DR. RUSSELL G JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
PRINCE WILLIAM HOSPITAL, 8700 SUDLEY ROAD, MANASSAS, VA 20011-4418
(703) 379-8000
Mailing address
17390 BERKSHIRE DR, JEFFERSONTON, VA 22724-1702
(540) 937-3969
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101028362
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5707200
—
VA
Enumeration date
12/11/2006
Last updated
07/08/2007
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