GLENN GERARD RUSSO M.D. NPI 1083683445

NPI Information

  • NPI: 1083683445
  • Provider Name: GLENN GERARD RUSSO, M.D.
  • Classification: Dermatology - 207NS0135X
  • Specialization: Procedural Dermatology
  • Entity Type: Individual
  • Address: 120 MEADOWCREST ST
    SUITE 160
    GRETNA, LA
    ZIP 70056
  • Phone: (504) 391-7620

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NPI Details

Glenn Gerard Russo, M.D. is a procedural dermatology dermatology in Gretna, LA. The provider is procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers). Glenn Gerard Russo, M.D. NPI is 1083683445. 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:

120 MEADOWCREST ST
SUITE 160
GRETNA, LA
ZIP 70056-255
Phone: (504) 391-7620
Fax: (504) 391-7624

The enumeration date for this NPI number is 3/16/2006 and was last updated on 2/3/2010.

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
1207NS0135XDermatologyProcedural Dermatology017336LOUISIANAYes

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
150622MEDICARE ID-TYPE UNSPECIFIEDLOUISIANA

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: 11/21/2025

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