Russell, Gary J
Russell, Gary J is an individual health care provider with primary practice located at 55 Fruit St Yaw 6, Boston MA 02114-2621. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Gastroenterology. Allopathic & Osteopathic Physicians / Pediatric Gastroenterology is his primary health care specialty. Russell, Gary J can be contacted via phone (617) 726-8705.Contact Information
Primary practice address
55 Fruit St Yaw 6
Boston MA 02114-2621
Phone: (617) 726-8705
Fax: (617) 724-2710
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 57051 | Massachusetts |
| Allopathic & Osteopathic Physicians / Pediatric Gastroenterology | 2080P0206X | 57051 | Massachusetts |
Profile Details
| NPI number | 1669463550 |
|---|---|
| LBN Legal business name | Russell, Gary J |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 31st, 2005 |
| Last updated | Aug 1st, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1669463550 | NPPES |
| Massachusetts | MEDICAID | 3036430 | |
| Massachusetts | Other | 057051 | |
| Massachusetts | Other | J07673 |
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