Provider Demographics
NPI:1497849715
Name:RUSSO, VINCENT JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:JOSEPH
Last Name:RUSSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SEAVIEW LN
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01951-2312
Mailing Address - Country:US
Mailing Address - Phone:978-852-8310
Mailing Address - Fax:978-462-0499
Practice Address - Street 1:16 SEAVIEW LN
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:MA
Practice Address - Zip Code:01951-2312
Practice Address - Country:US
Practice Address - Phone:978-852-8310
Practice Address - Fax:978-462-0499
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA28775208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery