Individual
CONCETTA M RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
123 SUMMER ST, SUITE 590, WORCESTER, MA 01608-1216
(508) 852-0600
Mailing address
159 NICHOLAS DRIVE, LANCASTER, MA 01523
(978) 706-1522
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
000062-1
NY
363A00000X
Physician Assistant
Primary
2518
MA
Other
Enumeration date
04/24/2007
Last updated
11/12/2008
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