| Provider / Organization | NPI | Date Certified |
|---|---|---|
| ERIK L. RUSSELL | 1710979695 | 2024-11-09 |
Erik L Russell [M] graduated in 1991 from Eastern Virginia Medical School and primarily specializes in Internal Medicine.
Erik L. Russell is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1710979695. Registration indicates Erik L. Russell is a provider of access to adult/geriatric primary care providers services with a specialization in Allopathic & Osteopathic Physicians, Internal Medicine Access to Pediatric Primary Care Providers (Allopathic & Osteopathic Physicians, Internal Medicine) (Internal Medicine, ) (Allopathic & Osteopathic Physicians, Internal Medicine) (Primary Care/Family Planning/APRN/PA, ) (Internal Medicine, Allopathic & Osteopathic Physicians) Access to Adult/Geriatric Primary Care Providers (Allopathic & Osteopathic Physicians, Internal Medicine) Access to Pediatric Primary Care Providers (Allopathic & Osteopathic Physicians, Internal Medicine) (Internal Medicine, ) (Allopathic & Osteopathic Physicians, Internal Medicine) (Primary Care/Family Planning/APRN/PA, ) (Internal Medicine, Allopathic & Osteopathic Physicians)
| PECOS ID | 5890826168 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Dr. Erik L. Russell M.D. |
| Practice Office Address | 281 MOIKE PL KAHULUI, HI US |
| Practice Office Telephone | 8087938943 |
| Practice Office Fax | 8084950159 |
| Mailing Address | 281 MOIKE PL KAHULUI, HI 967321106 US |
| Business Telephone | 8087938943 |
| Business Fax | 8084950159 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 7711 Quarterfield Rd Suite A | Glen Burnie, MD 210614492 | 4107615600 / 4107615734 |
| Code | Practice | License No State |
|---|---|---|
| 207R00000X | Access to Adult/Geriatric Primary Care Providers Allopathic & Osteopathic Physicians Internal MedicineAccess to Pediatric Primary Care Providers Allopathic & Osteopathic Physicians Internal Medicine Internal Medicine Allopathic & Osteopathic Physicians Internal Medicine Primary Care/Family Planning/APRN/PA Internal Medicine Allopathic & Osteopathic Physicians | D0043623
MD |
| 207R00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Allopathic & Osteopathic Physicians Internal MedicineAccess to Pediatric Primary Care Providers Allopathic & Osteopathic Physicians Internal Medicine Internal Medicine Allopathic & Osteopathic Physicians Internal Medicine Primary Care/Family Planning/APRN/PA Internal Medicine Allopathic & Osteopathic Physicians | MD-17813
HI |
| 110223993 | OTHER | MD | RR MEDICARE |
| 4492738 | OTHER | MD | AETNA FEE FOR S |
| P14805 | OTHER | MD | CAREFIRST MPOS |
| 1325758 | OTHER | MD | CIGNA PIN |
| 283838 | OTHER | MD | MAMSI SPECIALIS |
| 025440 | OTHER | MD | JHHC PROVIDER N |
| 312871700 | MEDICAID | MD | |
| 691700 | OTHER | MD | AETNA CAPITATED |
| 532650-04 | OTHER | MD | CAREFIRST MD RE |
| 883838 | OTHER | MD | MAMSI PRIMARY C |
| 7605-0044 | OTHER | MD | CAREFIRST BLUEC |