Provider Demographics
NPI:1316030356
Name:RUSSELL, ASELA C (MD)
Entity Type:Individual
Prefix:
First Name:ASELA
Middle Name:C
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 E PRENTICE AVE STE D10
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2728
Mailing Address - Country:US
Mailing Address - Phone:303-755-0120
Mailing Address - Fax:833-989-2368
Practice Address - Street 1:8000 E PRENTICE AVE STE D10
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2728
Practice Address - Country:US
Practice Address - Phone:303-755-0120
Practice Address - Fax:833-989-2368
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28049174400000X
CODR0028049207V00000X
CODR.0028049207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1280494Medicaid
COD28416Medicare UPIN
CO1280494Medicaid