Provider Demographics
NPI:1427030378
Name:COURNOYER, RUSSELL W JR (DPM)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:W
Last Name:COURNOYER
Suffix:JR
Gender:M
Credentials:DPM
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Mailing Address - Street 1:5 NEPONSET ST FL STREET12
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-856-9181
Mailing Address - Fax:508-425-6177
Practice Address - Street 1:5 NEPONSET ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2714
Practice Address - Country:US
Practice Address - Phone:508-856-9181
Practice Address - Fax:508-425-6177
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2018-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1767213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTRICARE/CHAMPUS
965657OtherFIRST HEALTH
480026268OtherRAILROAD MEDICARE
AA2838OtherHARVARD PILGRIM HEALTHCAR
042472266OtherTHREE RIVERS
Y70847OtherMEDICARE B
Y70910OtherBLUE SHIELD HMO BLUE
4886875OtherCIGNA PAL ID
9900050OtherFALLON COMMUNITY HLTH PL
26734OtherCHILDRENS MED SECURITY PL
7042342OtherAETNA/US HEALTHCARE
785949OtherMVP HEALTH CARE
042472266OtherONE HEALTH PLAN
26734OtherHEALTHY START
Y70910OtherBLUE CARE ELECT
Y70910OtherBLUE SHIELD INDEMNITY
0362093OtherMEDICAID/WELFARE
T32045Medicare UPIN
042472266OtherTHREE RIVERS