Provider Demographics
NPI:1376786434
Name:RUSSELL, INNA V (MD)
Entity Type:Individual
Prefix:DR
First Name:INNA
Middle Name:V
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:250 GREEN STREET
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440
Mailing Address - Country:US
Mailing Address - Phone:978-630-5050
Mailing Address - Fax:978-630-5059
Practice Address - Street 1:250 GREEN STREET
Practice Address - Street 2:SUITE 107
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440
Practice Address - Country:US
Practice Address - Phone:978-630-5050
Practice Address - Fax:978-630-5059
Is Sole Proprietor?:No
Enumeration Date:2009-04-19
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA238630207V00000X
IN01076359A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001242401Medicare PIN