Provider Demographics
NPI:1710228739
Name:RUSSELL JAMES GROUP, P.A.
Entity Type:Organization
Organization Name:RUSSELL JAMES GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HIBLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-721-2133
Mailing Address - Street 1:1589 ETON WAY
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1524
Mailing Address - Country:US
Mailing Address - Phone:410-721-2133
Mailing Address - Fax:866-695-6454
Practice Address - Street 1:857 PARK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4800
Practice Address - Country:US
Practice Address - Phone:410-244-0227
Practice Address - Fax:866-695-6454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01803103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700842903OtherINDIVIDUAL NPI
1700842903OtherINDIVIDUAL NPI