Provider Demographics
NPI:1407881600
Name:LIVINGSTON, RUSSELL L (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:L
Last Name:LIVINGSTON
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 1:202 W PLAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-4346
Mailing Address - Country:US
Mailing Address - Phone:617-943-2330
Mailing Address - Fax:810-267-9375
Practice Address - Street 1:202 W PLAIN ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-4346
Practice Address - Country:US
Practice Address - Phone:617-943-2330
Practice Address - Fax:810-267-9375
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA574142084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3153592Medicaid
MAJ16493OtherBCBS HMO PPO FEDERAL
MAY02673Medicare ID - Type Unspecified
E38395Medicare UPIN