Russo, Sam

Russo, Sam is an individual health care provider with primary practice located at 321 Main St Ste B , Winooski VT 05404-1380. He recently has 4 registered licenses in different health care specialties including Other Service Providers / Acupuncturist, Allopathic & Osteopathic Physicians / Sports Medicine, Allopathic & Osteopathic Physicians / General Practice, Other Service Providers / Naturopath. Other Service Providers / Naturopath is his primary health care specialty. Russo, Sam can be contacted via phone (802) 636-4133.

Contact Information

Primary practice address
321 Main St Ste B Winooski VT 05404-1380
Phone: (802) 636-4133
Fax: (833) 464-3117
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Acupuncturist 171100000X 091-0000176 Vermont
Allopathic & Osteopathic Physicians / Sports Medicine 2083S0010X 099-0000131 Vermont
Allopathic & Osteopathic Physicians / General Practice 208D00000X 099-0000131 Vermont
Other Service Providers / Naturopath 175F00000X 099-0000131 Vermont

Profile Details

NPI number 1891828398
LBN Legal business name Russo, Sam
Credentials N.D., LAC, RMSK
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 13th, 2007
Last updated May 1st, 2023 - about 3 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 1891828398 NPPES
Vermont MEDICAID 1015129

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