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Individual

DR. GARY D. RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
RT 11, LACKAWANNA TRAIL, NICHOLSON, PA 18446
(570) 942-6124
(570) 942-6193
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-3034
(570) 271-6144
(570) 271-6578

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD044346E
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001421212
PA
Enumeration date
04/26/2006
Last updated
07/14/2020
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