Provider Demographics
NPI:1700109451
Name:RUSSELL, LUCILLE JOYCE (MD)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:JOYCE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 PHEASANT RUN CIR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-3921
Mailing Address - Country:US
Mailing Address - Phone:215-579-2163
Mailing Address - Fax:215-579-2503
Practice Address - Street 1:1440 PHEASANT RUN CIR
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-3921
Practice Address - Country:US
Practice Address - Phone:215-579-2163
Practice Address - Fax:215-579-2503
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067024207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology