Russo, Jonathan Matt

Russo, Jonathan Matt is an individual health care provider with primary practice located at 47 Obery St Suite 201, Plymouth MA 02360-2229. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Russo, Jonathan Matt can be contacted via phone (508) 747-1560.

Contact Information

Primary practice address
47 Obery St Suite 201 Plymouth MA 02360-2229
Phone: (508) 747-1560
Fax: (508) 747-5155
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 49964 Massachusetts

Profile Details

NPI number 1184681892
LBN Legal business name Russo, Jonathan Matt
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 27th, 2006
Last updated Aug 25th, 2016 - about 9 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184681892 NPPES
Massachusetts MEDICAID 3020835

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