Provider Demographics
NPI:1366474959
Name:TURK, RUSSELL FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:FREDERICK
Last Name:TURK
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 1:1200 E PUTNAM AVE
Mailing Address - Street 2:RIVERSIDE OB/GYN
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1430
Mailing Address - Country:US
Mailing Address - Phone:203-637-3337
Mailing Address - Fax:203-637-3307
Practice Address - Street 1:1200 E PUTNAM AVE
Practice Address - Street 2:RIVERSIDE OB/GYN
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-1430
Practice Address - Country:US
Practice Address - Phone:203-637-3337
Practice Address - Fax:203-637-3307
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038686207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001386863Medicaid
CT010038686CT03OtherANTHEM BCBS PROVIDER #
CT001386863Medicaid
CT010038686CT03OtherANTHEM BCBS PROVIDER #