Provider Demographics
NPI:1467651505
Name:RUSSELL, DAWN S (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:S
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 1:1298 HARTFORD TPKE
Mailing Address - Street 2:APARTMENT #10 J
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2175
Mailing Address - Country:US
Mailing Address - Phone:203-469-7263
Mailing Address - Fax:
Practice Address - Street 1:330 CEDAR STREET
Practice Address - Street 2:BOARDMAN BUILDING, SECOND FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520
Practice Address - Country:US
Practice Address - Phone:203-785-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program