Provider Demographics
NPI:1184684508
Name:BIUNDO, RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:BIUNDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROSOLINO
Other - Middle Name:
Other - Last Name:BIUNDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1160 VAN VOORHIS RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3437
Mailing Address - Country:US
Mailing Address - Phone:304-598-1122
Mailing Address - Fax:304-598-1124
Practice Address - Street 1:1160 VAN VOORHIS RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3437
Practice Address - Country:US
Practice Address - Phone:304-598-1122
Practice Address - Fax:304-598-1124
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV16623208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD784081100OtherMARYLAND MEDICAID
124508400OtherDEPT OF LABOR WORK COMP
198177OtherFEDERAL BLACK LUNG
282258OtherALLIANCE PPO
311545097Other4 MOST HEALTH PLANS
WV0113386000Medicaid
1506998OtherGATEWAY HEALTH PLANS
311545097OtherHEALTH AMERICA HLTH ASSUR
E65412OtherCARELINK
WVMX2847OtherADVANTAGE HEALTH
4266957OtherAETNA
001712437OtherMT STATE BLUE CROSS BLUE
282258OtherGEHA
E65412Medicare UPIN
WVMX2847OtherADVANTAGE HEALTH
198177OtherFEDERAL BLACK LUNG
WVBI0709943Medicare PIN