Russo, Stephen A
Russo, Stephen A is an individual health care provider with primary practice located at 1500 Highlands Dr , Lititz PA 17543-7694. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Russo, Stephen A can be contacted via phone (717) 988-0000.Contact Information
Primary practice address
1500 Highlands Dr
Lititz PA 17543-7694
Phone: (717) 988-0000
Fax: (717) 782-5716
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA9106297 | Florida |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | MA057357 | Pennsylvania |
Profile Details
| NPI number | 1063783074 |
|---|---|
| LBN Legal business name | Russo, Stephen A |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 23rd, 2012 |
| Last updated | Apr 9th, 2021 - about 4 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 | 1063783074 | NPPES |
| Pennsylvania | MEDICAID | 103476544 |
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