| William M Russell, MD | |
|
5457 Twin Knolls Rd Ste 100, Columbia, MD 21045-3263 | |
| (410) 689-7400 | |
| Not Available |
| Full Name | William M Russell |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine - Geriatric Medicine |
| Location | 5457 Twin Knolls Rd Ste 100, Columbia, Maryland |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720178445 | NPI | - | NPPES |
| 39949003 | Other | BCBS OF MD | |
| 0012 | Other | BCBS OF DC | |
| 0943ER-399490-05 | Other | CAREFIRST BCBS OF MD | |
| 369001600 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | D0030182 (Maryland) | Secondary |
| 207RG0300X | Internal Medicine - Geriatric Medicine | D0030182 (Maryland) | Primary |
| Entity Name | Conviva Medical Center Management, LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1649324278 PECOS PAC ID: 4284717422 Enrollment ID: O20080212000415 |
| Mailing Address | Practice Location Address |
|---|---|
| William M Russell, MD 17855 Dallas Pkwy Ste 200, Dallas, TX 75287-6857 Ph: (800) 834-3059 | William M Russell, MD 5457 Twin Knolls Rd Ste 100, Columbia, MD 21045-3263 Ph: (410) 689-7400 |
Dr. Jon Kent Minford, M.D. Geriatric Medicine Medicare: Medicare Enrolled Practice Location: 10710 Charter Dr, Suite G020, Columbia, MD 21044 Phone: 410-964-2212 Fax: 410-964-0380 |
Dr. Jacob Cherian, M.D. Geriatric Medicine Medicare: Accepting Medicare Assignments Practice Location: 5450 Knoll North Dr, Columbia, MD 21045 Phone: 410-964-5311 Fax: 410-964-8578 |
Dr. Tejaswi Rajasekhara Sastry, M.D. Geriatric Medicine Medicare: Accepting Medicare Assignments Practice Location: 10710 Charter Dr, Suite G020, Columbia, MD 21044 Phone: 410-964-2212 Fax: 410-964-0380 |
Michael Howard Kelemen, M.D. Geriatric Medicine Medicare: Not Enrolled in Medicare Practice Location: 5450 Knoll North Dr, Suite 200b, Columbia, MD 21045 Phone: 410-964-5303 |
Dr. Joseph F Gibbons, M.D. Geriatric Medicine Medicare: Accepting Medicare Assignments Practice Location: 6250 Old Dobbin Ln, Columbia, MD 21045 Phone: 410-730-3399 Fax: 443-478-4737 |
Dr. Tin O Maung, M.D. Geriatric Medicine Medicare: Accepting Medicare Assignments Practice Location: 5999 Harpers Farm Rd Ste W250, Columbia, MD 21044 Phone: 410-772-8822 Fax: 410-772-9274 |
Dr. Jeffery Wayne Van Den Broek, D.O. Geriatric Medicine Medicare: Accepting Medicare Assignments Practice Location: 10710 Charter Dr, Suite 110, Columbia, MD 21044 Phone: 410-992-9797 Fax: 410-730-0942 |