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
State | License ID | Taxonomies |
---|---|---|
CT | 038686 | 207V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CT | 001386863 | Medicaid | |
CT | 010038686CT03 | Other | ANTHEM BCBS PROVIDER # |
CT | 001386863 | Medicaid | |
CT | 010038686CT03 | Other | ANTHEM BCBS PROVIDER # |