Provider Demographics
NPI:1154634418
Name:RUSSELL, WILLIAM BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRUCE
Last Name:RUSSELL
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 1:1120 ST. PAUL STRREET
Mailing Address - Street 2:GROUND LEVEL
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2685
Mailing Address - Country:US
Mailing Address - Phone:410-685-7790
Mailing Address - Fax:
Practice Address - Street 1:1120 SAINT PAUL ST
Practice Address - Street 2:GROUND LEVEL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2618
Practice Address - Country:US
Practice Address - Phone:410-685-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0013586208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation