Provider Demographics
NPI:1396159539
Name:RUSSELL, IAN (DO)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PUH SUITE E204
Mailing Address - Street 2:200 LOTHROP ST
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-647-3500
Mailing Address - Fax:412-647-0738
Practice Address - Street 1:PUH SUITE E204
Practice Address - Street 2:200 LOTHROP ST
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-647-3500
Practice Address - Fax:412-647-0738
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT016115207R00000X
PAOS0198712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine