Provider Demographics
NPI:1780909705
Name:RUSSELL, SHARMAN MAURISSA (MD)
Entity type:Individual
Prefix:DR
First Name:SHARMAN
Middle Name:MAURISSA
Last Name:RUSSELL
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Gender:
Credentials:MD
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Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-454-8181
Mailing Address - Fax:314-747-1429
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DIV OBGYN MFM AND ULTRASOUND
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-454-8181
Practice Address - Fax:314-747-1429
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2025-04-17
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Provider Licenses
StateLicense IDTaxonomies
MO2016020997207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200033887Medicaid