Provider Demographics
NPI:1114487972
Name:DINH, RUSSEL (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSEL
Middle Name:
Last Name:DINH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 MOUNTAIN AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-2736
Mailing Address - Country:US
Mailing Address - Phone:908-458-8333
Mailing Address - Fax:908-530-6522
Practice Address - Street 1:2002 MEDICAL PKWY STE 450
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3263
Practice Address - Country:US
Practice Address - Phone:410-224-6680
Practice Address - Fax:800-762-2852
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101285261207W00000X
DCMD600003666207W00000X
MDD0102596207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ083100Medicaid