Provider Demographics
NPI:1528008679
Name:RUSSELL, AIMEE GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:GEORGE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AIMEE
Other - Middle Name:JEANNE
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3700 SOUTHERN BLVD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1226
Mailing Address - Country:US
Mailing Address - Phone:937-281-3810
Mailing Address - Fax:937-281-3812
Practice Address - Street 1:3700 SOUTHERN BLVD.
Practice Address - Street 2:SUITE 101
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1226
Practice Address - Country:US
Practice Address - Phone:937-281-3810
Practice Address - Fax:937-281-3812
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350868052085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2697407Medicaid
OH2697407Medicaid
OHH005360Medicare PIN