Provider Demographics
NPI:1790891315
Name:RUSSO, DONALD J (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:RUSSO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:353 NEW SHACKLE ISLAND RD
Mailing Address - Street 2:#300C
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2379
Mailing Address - Country:US
Mailing Address - Phone:615-338-3337
Mailing Address - Fax:615-338-3329
Practice Address - Street 1:353 NEW SHACKLE ISLAND RD
Practice Address - Street 2:#300C
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2379
Practice Address - Country:US
Practice Address - Phone:615-338-3337
Practice Address - Fax:615-338-3329
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2022-01-27
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Provider Licenses
StateLicense IDTaxonomies
TN16008207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN60515OtherBCBS OF TN
TN3011296Medicaid
TN60515OtherBCBS OF TN
TNA97545Medicare UPIN