Provider Demographics
NPI:1639372345
Name:RUSSO, CHRISTOPHER JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:RUSSO
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 1:1345 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4776
Mailing Address - Country:US
Mailing Address - Phone:860-585-0000
Mailing Address - Fax:
Practice Address - Street 1:1345 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4776
Practice Address - Country:US
Practice Address - Phone:860-585-0000
Practice Address - Fax:860-584-5514
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14895207W00000X
CT053760207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1017993Medicaid
8705025OtherCIGNA
9507532OtherAETNA
1639372345OtherANTHEM
AA183908OtherHARVARD PILGRIM
NH30209796Medicaid
NH30209796Medicaid