Provider Demographics
NPI:1154319135
Name:OWENS, RUSSELL SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:SCOTT
Last Name:OWENS
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 1:100 CORPORATE CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1758
Mailing Address - Country:US
Mailing Address - Phone:717-763-1174
Mailing Address - Fax:717-763-8960
Practice Address - Street 1:100 CORPORATE CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1758
Practice Address - Country:US
Practice Address - Phone:717-763-1174
Practice Address - Fax:717-763-8960
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD042187E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
616847J5EMedicare ID - Type Unspecified
F55684Medicare UPIN