Russell, George H
Russell, George H is an individual health care provider with primary practice located at 887 Congress St Suite 320, Portland ME 04102-3100. 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, George H can be contacted via phone (207) 662-5522.Contact Information
Primary practice address
887 Congress St Suite 320
Portland ME 04102-3100
Phone: (207) 662-5522
Fax: (207) 662-5227
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 213288 | Massachusetts |
| Allopathic & Osteopathic Physicians / Pediatric Gastroenterology | 2080P0206X | 213288 | Massachusetts |
| Allopathic & Osteopathic Physicians / Pediatric Gastroenterology | 2080P0206X | MD20882 | Maine |
Profile Details
| NPI number | 1366423154 |
|---|---|
| LBN Legal business name | Russell, George H |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 8th, 2005 |
| Last updated | Aug 18th, 2016 - about 9 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 | 1366423154 | NPPES |
| Massachusetts | Other | 460383 | TUFTS HEALTH PLAN |
| Massachusetts | Other | J24704 | TUFTS HEALTH PLAN |
| Massachusetts | MEDICAID | 0192830 | TUFTS HEALTH PLAN |
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