Provider Demographics
NPI:1174584353
Name:RUSSELL BIUNDO MD INC
Entity type:Organization
Organization Name:RUSSELL BIUNDO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-598-1122
Mailing Address - Street 1:1160 VAN VOORHIS RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3437
Mailing Address - Country:US
Mailing Address - Phone:304-598-1122
Mailing Address - Fax:304-598-1124
Practice Address - Street 1:1160 VAN VOORHIS RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3437
Practice Address - Country:US
Practice Address - Phone:304-598-1122
Practice Address - Fax:304-598-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD784081100OtherMARYLAND MEDICAID
PA0016737660001OtherPENNSYLVANIA MEDICAID
1424801OtherUMWA
198177OtherFEDERAL BLACK LUNG
001707270OtherMT STATE BLUE CROSS BLUE
CG6938OtherRAILROAD MEDICARE
=========00OtherBRICKSTREET WORK COMP
001707270OtherMT STATE BLUE CROSS BLUE
198177OtherFEDERAL BLACK LUNG
=========OtherHEALTH ADVANTAGE
=========OtherCARELINK
=========OtherTRICARE CHAMPUS
CG6938OtherRAILROAD MEDICARE