DR. CHARLES E RUSSELL MD NPI 1245220912

NPI Information

NPI: 1245220912
Provider Name: DR. CHARLES E RUSSELL, MD
Classification: Preventive Medicine - 2083A0300X
Entity Type: Individual

Specialization: Addiction Medicine

PECOS Registration: Yes

Address:
579 RUSTIC TRL
BEAVERCREEK, OH
ZIP 45434
Phone: (937) 718-7677
Get Directions

DR. Charles E Russell, MD is an addiction medicine preventive medicine in Beavercreek, OH with 42 years of experience. The provider is a physician engaged in the subspecialty practice of Addiction Medicine who specializes in the prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction. DR. Charles E Russell, MD NPI is 1245220912. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: MICHIGAN STATE UNIVERSITY COLLEGE OF HUMAN MEDICINE
Graduation Year:1982

The provider's business location address is:

579 RUSTIC TRL
BEAVERCREEK, OH
ZIP 45434-337
Phone: (937) 718-7677
Fax: (937) 429-7441

The NPI 1245220912 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 10/25/2005 and was last updated on 4/15/2020.

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	2083A0300X	Preventive Medicine	Addiction Medicine	35050063	OHIO	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	0573348	MEDICAID	OHIO
2	000000546225	OTHER	OHIO	ANTHEM

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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