1538303904 NPI number — PAUL RUSSELL DMD

Table of content: PAUL RUSSELL DMD (NPI 1538303904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538303904 NPI number — PAUL RUSSELL DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSSELL
Provider First Name:
PAUL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538303904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 808 BOX 19
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FPO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09618-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
US NAVAL HOSPITAL
Provider Second Line Business Practice Location Address:
VIA CONTRADA BOSCARIELLO
Provider Business Practice Location Address City Name:
GRICIGNANO DI AVERSA
Provider Business Practice Location Address State Name:
CE
Provider Business Practice Location Address Postal Code:
81030
Provider Business Practice Location Address Country Code:
IT
Provider Business Practice Location Address Telephone Number:
81-811-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0008X , with the licence number:  0401415515 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)