Provider Demographics
NPI:1336164946
Name:RUSSELL, TOD S (MD)
Entity Type:Individual
Prefix:DR
First Name:TOD
Middle Name:S
Last Name:RUSSELL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1050 JABARA AVE
Mailing Address - Street 2:SEYMOUR JOHNSON AFB
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27531-2310
Mailing Address - Country:US
Mailing Address - Phone:919-722-0928
Mailing Address - Fax:919-722-1952
Practice Address - Street 1:1050 JABARA AVE
Practice Address - Street 2:SEYMOUR JOHNSON AFB
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27531-2310
Practice Address - Country:US
Practice Address - Phone:919-722-0928
Practice Address - Fax:919-722-1952
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PAMD048688L2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases