Provider Demographics
NPI:1366642282
Name:RUSSELL, MARION (MD)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:
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 1:106 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-8203
Mailing Address - Country:US
Mailing Address - Phone:781-283-2839
Mailing Address - Fax:781-283-3769
Practice Address - Street 1:106 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-8203
Practice Address - Country:US
Practice Address - Phone:817-283-2839
Practice Address - Fax:817-283-3769
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2266862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry