Provider Demographics
NPI:1083707962
Name:VASILE, RUSSELL GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:GEORGE
Last Name:VASILE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:RABB 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-4738
Mailing Address - Fax:617-975-5274
Practice Address - Street 1:25 BAY STATE RD
Practice Address - Street 2:SUITE ONE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2108
Practice Address - Country:US
Practice Address - Phone:617-437-9566
Practice Address - Fax:617-975-5274
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA382502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0132144Medicaid
MA0132144Medicaid
MAMO8937Medicare ID - Type UnspecifiedMEDICAIRE PROVIDER NUMBER