Provider Demographics
NPI:1275551608
Name:RUSSELL L HANDY MD PC
Entity Type:Organization
Organization Name:RUSSELL L HANDY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-282-8350
Mailing Address - Street 1:5875 BREMO ROAD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1934
Mailing Address - Country:US
Mailing Address - Phone:804-282-8350
Mailing Address - Fax:804-282-6506
Practice Address - Street 1:5875 BREMO ROAD
Practice Address - Street 2:SUITE 701
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-282-8350
Practice Address - Fax:804-282-6506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036484207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6243410Medicaid
063196OtherANTHEM
57740OtherSOUTHERN HEALTH
0539488OtherAETNA
21655OtherMAMSI
063196OtherANTHEM