Provider Demographics
NPI:1336332998
Name:DR RUSSELL O SCHUB PA
Entity Type:Organization
Organization Name:DR RUSSELL O SCHUB PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:O
Authorized Official - Last Name:SCHUB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-730-1000
Mailing Address - Street 1:8875 CENTRE PARK DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2382
Mailing Address - Country:US
Mailing Address - Phone:410-730-1000
Mailing Address - Fax:410-730-8615
Practice Address - Street 1:8875 CENTRE PARK DR
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2382
Practice Address - Country:US
Practice Address - Phone:410-730-1000
Practice Address - Fax:410-730-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD526471500Medicaid
MD8338RUOtherBLUE SHIELD
DCC428OtherBLUE SHIELD
DCC428OtherBLUE SHIELD
MD8338RUOtherBLUE SHIELD
MD526471500Medicaid
8338Medicare PIN