Provider Demographics
NPI:1679554042
Name:RUSSELL, STEVEN JON (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JON
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MD PHD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-8722
Mailing Address - Fax:617-724-8534
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:WEL 501
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-3966
Practice Address - Fax:617-726-7543
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-11-07
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Provider Licenses
StateLicense IDTaxonomies
MA219939207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine