Provider Demographics
NPI:1346210176
Name:RUSSELL, EUGENE FAIRCHILD (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:FAIRCHILD
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 1:3006 REDFORD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3116
Mailing Address - Country:US
Mailing Address - Phone:336-288-2218
Mailing Address - Fax:
Practice Address - Street 1:3006 REDFORD DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-3116
Practice Address - Country:US
Practice Address - Phone:336-288-2218
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19540207V00000X
VA17481207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC 8974051Medicaid
NCC86249Medicare UPIN