Provider Demographics
NPI:1255386074
Name:NOBLETT, RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:
Last Name:NOBLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4461 STARKEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018
Mailing Address - Country:US
Mailing Address - Phone:540-345-4946
Mailing Address - Fax:540-982-7164
Practice Address - Street 1:4461 STARKEY ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-345-4946
Practice Address - Fax:540-343-7693
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053399207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA140116OtherANTHEM
VA4601654OtherCIGNA
VA7280194OtherAETNA
VA110212716OtherRAILROAD MEDICARE
VA1255386074Medicaid
VA315994OtherSOUTHERN HEALTH
VA1255386074Medicaid
VA315994OtherSOUTHERN HEALTH