Basic Information
| Provider Information | |||||||||
| NPI: | 1255535258 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARONE | ||||||||
| FirstName: | RUSSELL | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 5TH AVE W | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287394263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286971343 | ||||||||
| FaxNumber: | 8286973224 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 5TH AVE W | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287394206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286971343 | ||||||||
| FaxNumber: | 8286973224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2007 | ||||||||
| LastUpdateDate: | 08/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 125 | NC | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | P00862374 | 01 | MEDICARE RAILROAD | OTHER | 56-1514942 | 01 | NC | PRIVATE INSURANCE | OTHER | 08009 | 01 | NC | BCBS OF NC | OTHER |