Provider Demographics
NPI:1447397583
Name:RUSSELL, JESSICA BRANNON (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:BRANNON
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:KATHERINE
Other - Last Name:BRANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2000 MEDICAL PKWY STE 306
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3745
Mailing Address - Country:US
Mailing Address - Phone:410-980-3729
Mailing Address - Fax:
Practice Address - Street 1:2000 MEDICAL PKWY STE 306
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3745
Practice Address - Country:US
Practice Address - Phone:410-571-9700
Practice Address - Fax:410-571-9710
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0068757207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0068757OtherMEDICAL LICENSE