Provider Demographics
NPI:1447254297
Name:HESS, RUSSELL CARLISLE (DO)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:CARLISLE
Last Name:HESS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:MC SHERRYSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17344-2116
Mailing Address - Country:US
Mailing Address - Phone:717-637-4188
Mailing Address - Fax:717-637-7803
Practice Address - Street 1:70 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:MC SHERRYSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17344-2116
Practice Address - Country:US
Practice Address - Phone:717-637-4188
Practice Address - Fax:717-637-7803
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006862L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1243569Medicaid
PA582297OtherMEDICARE LEGACY PROVIDER
PA582297OtherMEDICARE LEGACY PROVIDER
PA671095ZEA5Medicare PIN
PA671095JPLMedicare PIN