Provider Demographics
NPI:1477548394
Name:BLINDER, RUSSELL ALAN (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ALAN
Last Name:BLINDER
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:44 BINNEY ST
Mailing Address - Street 2:RADIOLOGY, DANA-FARBER CANCER INSTITUTE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6013
Mailing Address - Country:US
Mailing Address - Phone:617-632-3306
Mailing Address - Fax:617-632-5579
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:RADIOLOGY, BRIGHAM AND WOMEN'S HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-632-3306
Practice Address - Fax:617-632-5579
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2007-08-13
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Provider Licenses
StateLicense IDTaxonomies
MA1594712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ19873OtherBLUE CROSS/BLUE SHIELD
MA3191168Medicaid
MA159471OtherTUFTS HEALTH CARE
MA240794BWHTOtherHARVARD PILGRIM HEALTH CA
MAJ19873OtherBLUE CROSS/BLUE SHIELD
MA240794BWHTOtherHARVARD PILGRIM HEALTH CA