Provider Demographics
NPI:1932790953
Name:WILLIAMS, RUSSELL EARL JR
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:EARL
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 FORBES AVE FL 8
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3317
Mailing Address - Country:US
Mailing Address - Phone:412-469-7726
Mailing Address - Fax:412-586-9102
Practice Address - Street 1:3501 FORBES AVE FL 8
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3317
Practice Address - Country:US
Practice Address - Phone:412-469-7726
Practice Address - Fax:412-586-9102
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist