Individual
MARK A. RUSSELL
Active
Individual
MARK A. RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
0101230382
VA
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
0101230382
VA
Other
Enumeration date
11/07/2006
Last updated
09/02/2025
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