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Individual

DR. RUSSELL E CARLSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1093 DELAWARE AVE APT 5, BUFFALO, NY 14209-1655
(716) 462-4415
(716) 303-7008
Mailing address
PO BOX 7, BUFFALO, NY 14207-0007
(716) 462-4415
(716) 303-7008

Taxonomy

Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
189175
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00025759601
UNIVERA HEALTHCARE
NY
01
000526654001
BLUE CROSS/ BLUE SHIELD
NY
01
010549324
NOVA INSURANCE
NY
05
02212417
NY
01
040426002783
FIDELIS
NY
01
2197606
INDEPENDENT HEALTH
NY
01
7099868
GHI
NY
01
780002093
RAILROAD MCR
NY
01
PAR05802
NORTH AMERICAN ADMINISTRT
NY
Enumeration date
08/20/2006
Last updated
10/28/2023
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