Provider Demographics
NPI:1447325774
Name:RUSSELL, JOHN ALDEN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALDEN
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 FOREST AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6850
Mailing Address - Country:US
Mailing Address - Phone:804-288-7980
Mailing Address - Fax:
Practice Address - Street 1:513 FOREST AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-6850
Practice Address - Country:US
Practice Address - Phone:804-288-7980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010259612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry