Provider Demographics
NPI:1003840505
Name:RUSSO, MICHAEL PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:RUSSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-7800
Mailing Address - Fax:717-812-7811
Practice Address - Street 1:4222 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17406-8083
Practice Address - Country:US
Practice Address - Phone:717-812-7800
Practice Address - Fax:717-812-7811
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023752E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1142793OtherAMERIHEALTH MERCY-WMG
PA36693OtherGEISINGER
PA0068412000OtherAMERIHEALTH 65 PA
PA1517480OtherGATEWAY-WMG
PA000985796Medicaid
PA086178OtherHIGHMARK BLUE SHIELD
PA348556OtherMAMSI-WMG
PA30115669OtherAMERIHEALTH MERCY - WMG
PA4545155OtherAETNA
PA30120490OtherAMERIHEALTH MERCY - YH
PA20072397OtherAMERIHEALTH MERCY-YHOBGYN
PA03124601OtherCAPITAL BLUE CROSS-WMG
PA032661OtherJOHNS HOPKINS
MD053883300Medicaid
MD524955OtherCAREFIRST MD BCBS
PA81659OtherUNISON-WMG
MD524955OtherCAREFIRST MD BCBS
PA4545155OtherAETNA
PA348556OtherMAMSI-WMG
PA160042899Medicare PIN
PA086178FLTMedicare PIN