Provider Demographics
NPI:1700193018
Name:HARGROVE, RUSSELL A (CRNA)
Entity Type:Individual
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First Name:RUSSELL
Middle Name:A
Last Name:HARGROVE
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:50 N LA CIENEGA BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2246
Mailing Address - Country:US
Mailing Address - Phone:215-456-7000
Mailing Address - Fax:215-254-3289
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:TOWER 3
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-3958
Practice Address - Fax:215-456-8539
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2016-08-17
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Provider Licenses
StateLicense IDTaxonomies
PARN578914367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered