Basic Information
| Provider Information | |||||||||
| NPI: | 1548758907 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUSSO | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | BRICE | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 EHRHARDT STREET MSC 861 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294250001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437920192 | ||||||||
| FaxNumber: | 8438767111 | ||||||||
| Practice Location | |||||||||
| Address1: | 67 PRESIDENT ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294255712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437097981 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2018 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | LL52723 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2084P0800X | LL52723 | SC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.