Provider Demographics
NPI:1780678391
Name:MCDOW, RUSSELL EDWARD JR (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:EDWARD
Last Name:MCDOW
Suffix:JR
Gender:M
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 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-443-6717
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:44055 RIVERSIDE PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5179
Practice Address - Country:US
Practice Address - Phone:703-858-3131
Practice Address - Fax:703-858-3130
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032827208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010398398Medicaid
VA010092531Medicaid
VAP00142427OtherRR MEDICARE
VA010398398Medicaid
VA004683L19Medicare PIN