Provider Demographics
NPI:1740323955
Name:RUSSELL, MAUREEN M (MD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:M
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 1:301 OHIO RIVER BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1300
Mailing Address - Country:US
Mailing Address - Phone:412-741-6530
Mailing Address - Fax:412-741-9274
Practice Address - Street 1:301 OHIO RIVER BLVD STE 301
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1300
Practice Address - Country:US
Practice Address - Phone:412-741-6530
Practice Address - Fax:412-741-9274
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059428L207V00000X
PAMD059426L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103987OtherUPMC NUMBER
PAPA STATE LICENSEOtherMD059428L
PA0015932440003Medicaid
PARU882557OtherBLUE SHIELD ID NUBMER
PA0015932440003Medicaid
PAPA STATE LICENSEOtherMD059428L