Individual
PATRICK J RUSSO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2555 COURT DR, SUITE 300, GASTONIA, NC 28054-2134
(704) 868-3256
(704) 868-5870
Mailing address
2555 COURT DR, SUITE 200, GASTONIA, NC 28054-2134
(704) 868-3256
(704) 868-5870
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
200301049
NC
207RC0000X
Cardiovascular Disease Physician
26794
SC
207UN0901X
Nuclear Cardiology Physician
200301049
NC
207UN0901X
Nuclear Cardiology Physician
26794
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891345R
—
NC
05
—
N01046
—
SC
Enumeration date
07/11/2005
Last updated
06/08/2017
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