Provider Demographics
NPI:1639311384
Name:RUSSELL DROZDIAK
Entity Type:Organization
Organization Name:RUSSELL DROZDIAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DROZDIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-254-4314
Mailing Address - Street 1:349 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CLYMER
Mailing Address - State:PA
Mailing Address - Zip Code:15728-1173
Mailing Address - Country:US
Mailing Address - Phone:724-254-4134
Mailing Address - Fax:724-254-2350
Practice Address - Street 1:349 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CLYMER
Practice Address - State:PA
Practice Address - Zip Code:15728-1173
Practice Address - Country:US
Practice Address - Phone:724-254-4134
Practice Address - Fax:724-254-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty