DR. GARY J RUSSELL MD NPI 1669463550

NPI Information

NPI: 1669463550
Provider Name: DR. GARY J RUSSELL, MD
Classification: Pediatrics - 2080P0206X
Entity Type: Individual

Specialization: Pediatric Gastroenterology

PECOS Registration: Yes

Address:
55 FRUIT ST
YAW 6
BOSTON, MA
ZIP 02114
Phone: (617) 726-8705
Get Directions

DR. Gary J Russell, MD is a pediatric gastroenterology pediatrics in Boston, MA. The provider is a pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs. DR. Gary J Russell, MD NPI is 1669463550. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

55 FRUIT ST
YAW 6
BOSTON, MA
ZIP 02114-621
Phone: (617) 726-8705
Fax: (617) 724-2710

The NPI 1669463550 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/31/2005 and was last updated on 8/1/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208000000X	Pediatrics		57051	MASSACHUSETTS	No
2	2080P0206X	Pediatrics	Pediatric Gastroenterology	57051	MASSACHUSETTS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	057051	OTHER	MASSACHUSETTS	TUFTS HEALTH PLAN
2	3036430	MEDICAID	MASSACHUSETTS
3	A14178	MEDICARE UPIN
4	J07673	MEDICARE ID-TYPE UNSPECIFIED	MASSACHUSETTS
5	J07673	OTHER	MASSACHUSETTS	BCBS MA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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