Russell James Group, P.a. | |
857 Park Ave Baltimore MD 21201-4800 | |
(410) 244-0227 | |
(866) 695-6454 |
Full Name | Russell James Group, P.a. |
---|---|
Speciality | Psychologist |
Location | 857 Park Ave, Baltimore, Maryland |
Authorized Official Name and Position | Russell J Hibler (OWNER) |
Authorized Official Contact | 4107212133 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Russell James Group, P.a. 1589 Eton Way Crofton MD 21114-1524 Ph: (410) 721-2133 | Russell James Group, P.a. 857 Park Ave Baltimore MD 21201-4800 Ph: (410) 244-0227 |
NPI Number | 1710228739 |
---|---|
Provider Enumeration Date | 03/15/2013 |
Last Update Date | 02/12/2015 |
Medicare PECOS PAC ID | 9335388610 |
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Medicare Enrollment ID | O20130618000033 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710228739 | NPI | - | NPPES |
1700842903 | Other | INDIVIDUAL NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | 01803 (Maryland) | Primary |
Provider Name | Russell J Hibler |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1700842903 PECOS PAC ID: 0547345324 Enrollment ID: I20080305000061 |
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