Individual
DR. SAM RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.D., LAC, RMSK
Contact information
Practice address
321 MAIN ST STE B, WINOOSKI, VT 05404-1380
(802) 636-4133
(833) 464-3117
Mailing address
321 MAIN ST STE B, WINOOSKI, VT 05404-1380
(802) 636-4133
(833) 464-3117
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
091-0000176
VT
175F00000X
Naturopath
Primary
099-0000131
VT
2083S0010X
Sports Medicine (Preventive Medicine) Physician
099-0000131
VT
208D00000X
General Practice Physician
099-0000131
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015129
—
VT
Enumeration date
03/13/2007
Last updated
05/01/2023
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