Provider Demographics
NPI:1558338533
Name:RUSSO, MARGARET A (MD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:A
Last Name:RUSSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-4252
Mailing Address - Country:US
Mailing Address - Phone:413-320-1139
Mailing Address - Fax:
Practice Address - Street 1:49 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-4252
Practice Address - Country:US
Practice Address - Phone:413-320-1139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME469026OtherTUFTS
MA110037879AMedicaid
MAJ27504OtherBLUE CROSS AND BLUE SHIEL
ME469026OtherTUFTS
MA110037879AMedicaid
MAF94997Medicare UPIN
ME469026OtherTUFTS
MAJ27504OtherBLUE CROSS AND BLUE SHIEL
MA2064529Medicaid