Provider Demographics
NPI:1306183215
Name:TONKIN, RUSSELL J (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:J
Last Name:TONKIN
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 1:131 WINDY LN
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:VT
Mailing Address - Zip Code:05056-4416
Mailing Address - Country:US
Mailing Address - Phone:802-672-3179
Mailing Address - Fax:
Practice Address - Street 1:131 WINDY LN
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:VT
Practice Address - Zip Code:05056-4416
Practice Address - Country:US
Practice Address - Phone:802-672-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0010168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine