Provider Demographics
NPI:1285607143
Name:REES, RUSSELL EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:EUGENE
Last Name:REES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:570-887-2904
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425473207V00000X
NY179186-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACC9269OtherRR MEDICARE GROUP
PA1011797650001Medicaid
NYCC8362OtherRR MEDICARE GROUP
NYP00213253OtherRR MEDICARE PIN
PAP00213253OtherRR MEDICARE PIN
NY02620097Medicaid
PAGU039794OtherPA MEDICARE GROUP
PA1011797650001Medicaid
PAP00213253OtherRR MEDICARE PIN
PA086557N8LMedicare ID - Type Unspecified