Provider Demographics
NPI:1245436542
Name:NORD, RUSSELL MARC (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:MARC
Last Name:NORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:38690 STIVERS ST STE A
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5276
Mailing Address - Country:US
Mailing Address - Phone:510-248-1040
Mailing Address - Fax:510-797-7426
Practice Address - Street 1:38690 STIVERS ST
Practice Address - Street 2:SUITE A
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5279
Practice Address - Country:US
Practice Address - Phone:510-248-1040
Practice Address - Fax:510-797-7426
Is Sole Proprietor?:No
Enumeration Date:2007-06-23
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA103896207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51941Medicaid