Provider Demographics
NPI:1740401470
Name:RUSSELL, NATHANIEL DUANE (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:DUANE
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:972 POPPY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8125
Mailing Address - Country:US
Mailing Address - Phone:614-420-6344
Mailing Address - Fax:614-759-6281
Practice Address - Street 1:750 MOUNT CARMEL MALL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1553
Practice Address - Country:US
Practice Address - Phone:614-224-6420
Practice Address - Fax:614-224-6423
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2011-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35.082556207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine