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| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Bertram R. Russell | [sources] | |||
| Birth date | not available | [sources] | |||
| Nationality | not available | [sources] | |||
| Country | United States of America | [sources] | |||
| First name | Bertram | [sources] | |||
| ID Number | MD020168E | [sources] | |||
| Last name | Russell | [sources] | |||
| Middle name | R. | [sources] | |||
| NPI | 1386664407 | [sources] | |||
| Title | MD | [sources] | |||
| Address | (WV), (WV) | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers who are precluded from participation in the Medical Assistance Program
United States of America · DHS
For experts: raw data explorer
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| Sanctions | |||||
|---|---|---|---|---|---|
| Country | Authority | Program | Start date | End date | |
| United States of America | Department of Human Services | - | |||
| Address | ||
|---|---|---|
| Full address | Country | |
| (WV), (WV) · - WV, - WV · WV, WV | United States of America | |