Provider Demographics
NPI:1477624823
Name:RUSSELL-BROWN, KARL EVERTON (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:EVERTON
Last Name:RUSSELL-BROWN
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 1:203 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-2426
Mailing Address - Country:US
Mailing Address - Phone:908-756-5550
Mailing Address - Fax:908-756-3072
Practice Address - Street 1:203 W 9TH ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-2426
Practice Address - Country:US
Practice Address - Phone:908-756-5550
Practice Address - Fax:908-756-3072
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA034270002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0966809Medicaid