Medders, Russell Glen
Medders, Russell Glen is an individual health care provider with primary practice located at 4600 Lake Boone Trail Suite 100, Raleigh NC 27607-7529. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as his primary health care specialty. Medders, Russell Glen can be contacted via phone (919) 787-1374.Contact Information
Primary practice address
4600 Lake Boone Trail Suite 100
Raleigh NC 27607-7529
Phone: (919) 787-1374
Fax: (919) 571-8135
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Otolaryngology | 207Y00000X | 29710 | North Carolina |
Profile Details
| NPI number | 1376501049 |
|---|---|
| LBN Legal business name | Medders, Russell Glen |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 3rd, 2006 |
| Last updated | Jul 9th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376501049 | NPPES |
| North Carolina | Other | 040002669 | RAILROAD MEDICARE |
| North Carolina | Other | 1050117 | RAILROAD MEDICARE |
| North Carolina | MEDICAID | 8958402 | RAILROAD MEDICARE |
| North Carolina | Other | 58402 | RAILROAD MEDICARE |
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