Russell, Richard B

Russell, Richard B is an individual health care provider with primary practice located at 121 N Tulpehocken St , Pine Grove PA 17963-1217. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Russell, Richard B can be contacted via phone (570) 345-2345.

Contact Information

Primary practice address
121 N Tulpehocken St Pine Grove PA 17963-1217
Phone: (570) 345-2345
Fax: (570) 345-2350
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X OS004201L Pennsylvania

Profile Details

NPI number 1144213240
LBN Legal business name Russell, Richard B
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 24th, 2005
Last updated Nov 1st, 2007 - about 17 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144213240 NPPES
Pennsylvania MEDICAID 0007538350005

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