Individual
ANTHONY ROBERT RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2696
(617) 726-2000
Mailing address
16 ANCHOR CT, WEST BABYLON, NY 11704-7422
(631) 793-8174
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/23/2022
Last updated
03/23/2022
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