Provider Demographics
NPI:1093236945
Name:RUSSO, CORRINE M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CORRINE
Middle Name:M
Last Name:RUSSO
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3700 COLLEGE AVE APT 402
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4641
Mailing Address - Country:US
Mailing Address - Phone:410-294-7246
Mailing Address - Fax:
Practice Address - Street 1:8860 COLUMBIA 100 PKWY STE 400
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:410-964-8346
Practice Address - Fax:410-964-4412
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2018-07-09
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant