| Russell Pet M.d. Inc | |
|
4 Hartwell St Fall River MA 02721-3019 | |
| (508) 675-0089 | |
| (508) 675-2233 |
| Full Name | Russell Pet M.d. Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4 Hartwell St, Fall River, Massachusetts |
| Authorized Official Name and Position | L Russell Pet (PRESIDENT) |
| Authorized Official Contact | 5086750089 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Russell Pet M.d. Inc 4 Hartwell St Fall River MA 02721-3019 Ph: (508) 675-0089 | Russell Pet M.d. Inc 4 Hartwell St Fall River MA 02721-3019 Ph: (508) 675-0089 |
| NPI Number | 1710204391 |
|---|---|
| Provider Enumeration Date | 04/22/2010 |
| Last Update Date | 04/22/2010 |
| Medicare PECOS PAC ID | 9032235288 |
|---|---|
| Medicare Enrollment ID | O20100925000132 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710204391 | NPI | - | NPPES |
| 3154564 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Primary |
| Provider Name | L Pet |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194745257 PECOS PAC ID: 9830187558 Enrollment ID: I20040503000838 |
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