1922451616 NPI number — MR. DONALD E. RUSSELL IV MS, LAT, ATC

Table of content: MR. DONALD E. RUSSELL IV MS, LAT, ATC (NPI 1922451616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922451616 NPI number — MR. DONALD E. RUSSELL IV MS, LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSSELL
Provider First Name:
DONALD
Provider Middle Name:
E.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
IV
Provider Credential Text:
MS, LAT, ATC
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:
1922451616
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
226 TALL OAK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CUMBERLAND
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17070-2347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-290-1190
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 S BALTIMORE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DILLSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17019-9636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-432-8691
Provider Business Practice Location Address Fax Number:
717-432-7393
Provider Enumeration Date:
07/18/2016

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: 2255A2300X , with the licence number:  RT005841 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com