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Individual

MATTHEW SCOTT RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
41 MONTVALE AVE STE 200, STONEHAM, MA 02180-2445
(781) 279-0971
Mailing address
41 MONTVALE AVE STE 200, STONEHAM, MA 02180-2445
(781) 279-0971

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
294420
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
A103049
STATE MEDICAL LICENSE
CA
Enumeration date
03/28/2008
Last updated
09/23/2022
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