1184684508 NPI number — RUSSELL BIUNDO MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184684508 NPI number — RUSSELL BIUNDO MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BIUNDO

Provider First Name:

RUSSELL

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

BIUNDO

Provider Other First Name:

ROSOLINO

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

MD

Provider Other Last Name Type Code:

5

NPI Number:

1184684508

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/05/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1160 VAN VOORHIS RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MORGANTOWN

Provider Business Mailing Address State Name:

WV

Provider Business Mailing Address Postal Code:

26505-3437

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

304-598-1122

Provider Business Mailing Address Fax Number:

304-598-1124

Provider First Line Business Practice Location Address:

1160 VAN VOORHIS RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MORGANTOWN

Provider Business Practice Location Address State Name:

WV

Provider Business Practice Location Address Postal Code:

26505-3437

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

304-598-1122

Provider Business Practice Location Address Fax Number:

304-598-1124

Provider Enumeration Date:

03/28/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208100000X , with the licence number:  WV16623 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 784081100 . This is a "MARYLAND MEDICAID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 124508400 . This is a "DEPT OF LABOR WORK COMP" identifier . This identifiers is of the category "OTHER".
• Identifier: 198177 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".
• Identifier: 282258 . This is a "ALLIANCE PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 311545097 . This is a "4 MOST HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
• Identifier: 0113386000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 1506998 . This is a "GATEWAY HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
• Identifier: 311545097 . This is a "HEALTH AMERICA HLTH ASSUR" identifier . This identifiers is of the category "OTHER".
• Identifier: E65412 . This is a "CARELINK" identifier . This identifiers is of the category "OTHER".
• Identifier: WVMX2847 . This is a "ADVANTAGE HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 4266957 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 001712437 . This is a "MT STATE BLUE CROSS BLUE" identifier . This identifiers is of the category "OTHER".
• Identifier: 282258 . This is a "GEHA" identifier . This identifiers is of the category "OTHER".