Individual
MARK A. RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1221 LEE ST, CHARLOTTESVILLE, VA 22908-0001
(434) 924-5115
(434) 244-4504
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
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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