Basic Information
| Provider Information | |||||||||
| NPI: | 1386625655 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUSSMAN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1050 BOWER HILL RD | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152431800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123444767 | ||||||||
| FaxNumber: | 4123440405 | ||||||||
| Practice Location | |||||||||
| Address1: | 1050 BOWER HILL RD | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152431800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123444767 | ||||||||
| FaxNumber: | 4123440405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2005 | ||||||||
| LastUpdateDate: | 11/07/2007 | ||||||||
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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 | 207RC0000X | MD008156E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 87154 | 01 | HEALTH AMERICA | OTHER | 1001032 | 01 | GATEWAY HEALTH PLAN | OTHER | 059283 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 2061367 | 01 | AETNA | OTHER | 000734040003 | 05 | PA | MEDICAID | 000000084776 | 01 | UNISON HEALTH PLAN | OTHER |