Provider Demographics
NPI:1073686572
Name:KERSCHMANN, RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:KERSCHMANN
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 1:3737 LAUREL WAY
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-0000
Mailing Address - Country:US
Mailing Address - Phone:650-780-9346
Mailing Address - Fax:415-962-4154
Practice Address - Street 1:967 MABURY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1025
Practice Address - Country:US
Practice Address - Phone:800-288-8008
Practice Address - Fax:408-975-1030
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA57159174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG57159OtherCA STATE LICENSE
CABJ422YOtherMEDICARE PTAN
CAG57159OtherCA STATE LICENSE
CA00G571590Medicare PIN