Provider Demographics
NPI:1700938776
Name:RUSSEK, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:RUSSEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 LINGLESTOWN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3347
Mailing Address - Country:US
Mailing Address - Phone:717-233-3630
Mailing Address - Fax:717-233-3439
Practice Address - Street 1:1800 LINGLESTOWN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3347
Practice Address - Country:US
Practice Address - Phone:717-233-3630
Practice Address - Fax:717-233-3439
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035844L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA462629OtherPROVIDER ID