Russell, Matthew L.
Russell, Matthew L. is an individual health care provider with primary practice located at 1200 Centre Street Department Of Medicine, Roslindale MA 02131. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine, Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine. Allopathic & Osteopathic Physicians / Geriatric Medicine is his primary health care specialty. Russell, Matthew L. can be contacted via phone (617) 363-8849.Contact Information
Primary practice address
1200 Centre Street Department Of Medicine
Roslindale MA 02131
Phone: (617) 363-8849
Fax: (617) 363-8929
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 207327 | Massachusetts |
| Allopathic & Osteopathic Physicians / Geriatric Medicine | 207RG0300X | 207327 | Massachusetts |
| Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine | 207RH0002X | 207327 | Massachusetts |
Profile Details
| NPI number | 1699723627 |
|---|---|
| LBN Legal business name | Russell, Matthew L. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 4th, 2006 |
| Last updated | Sep 29th, 2015 - 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 | 1699723627 | NPPES |
| Massachusetts | MEDICAID | 10033265A | |
| Massachusetts | Other | S400169483 |
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