Provider Demographics
NPI:1578855433
Name:RUSSELL, JOSEPH L A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L A
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7555 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-4211
Mailing Address - Country:US
Mailing Address - Phone:843-576-3302
Mailing Address - Fax:843-797-8372
Practice Address - Street 1:7555 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-4211
Practice Address - Country:US
Practice Address - Phone:843-576-3302
Practice Address - Fax:843-797-8372
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6275207YX0905X
SC51474207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery