Provider Demographics
NPI:1386625655
Name:RUSSMAN, RICHARD B (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:RUSSMAN
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 1:1050 BOWER HILL RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1800
Mailing Address - Country:US
Mailing Address - Phone:412-344-4767
Mailing Address - Fax:412-344-0405
Practice Address - Street 1:1050 BOWER HILL RD
Practice Address - Street 2:SUITE 308
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1800
Practice Address - Country:US
Practice Address - Phone:412-344-4767
Practice Address - Fax:412-344-0405
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD008156E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
87154OtherHEALTH AMERICA
1001032OtherGATEWAY HEALTH PLAN
PA059283OtherHIGHMARK BLUE SHIELD
2061367OtherAETNA
PA000734040003Medicaid
000000084776OtherUNISON HEALTH PLAN
PA059283Medicare PIN
PA000734040003Medicaid