Provider Demographics
NPI:1730113812
Name:RUSSELL, VICTORIA (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
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:PO BOX 520
Mailing Address - Street 2:1986 LOWER ELMORE MOUNTAIN RD.
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-0520
Mailing Address - Country:US
Mailing Address - Phone:802-888-5955
Mailing Address - Fax:
Practice Address - Street 1:BOX 520
Practice Address - Street 2:1986 LOWER ELMORE MOUNTAIN ROAD BOX 520
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-0520
Practice Address - Country:US
Practice Address - Phone:802-888-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00099952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B72945Medicare UPIN