Basic Information
| Provider Information | |||||||||
| NPI: | 1245272376 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAWYER | ||||||||
| FirstName: | RUSSELL | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 79777 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212790777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4346547794 | ||||||||
| FaxNumber: | 4348234567 | ||||||||
| Practice Location | |||||||||
| Address1: | 1646 PARK RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | CROZET | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4348234567 | ||||||||
| FaxNumber: | 4348234272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 07/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101045650 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.