Provider Demographics
NPI:1205148707
Name:RUSSELL, JONATHON O (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:O
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:601 N. CAROLINE ST.
Mailing Address - Street 2:6TH FLOOR OTOLARYNGOLOGY HEAD AND NECK SURGERY
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287
Mailing Address - Country:US
Mailing Address - Phone:410-955-6420
Mailing Address - Fax:410-614-8610
Practice Address - Street 1:601 N. CAROLINE ST.
Practice Address - Street 2:6TH FLOOR OTOLARYNGOLOGY HEAD AND NECK SURGERY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:410-955-6420
Practice Address - Fax:410-614-8610
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAC2895437L2207Y00000X
MDD0079238207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology