Provider Demographics
NPI:1710979695
Name:RUSSELL, ERIK L (MD)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:L
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 1:281 MOIKE PL
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1106
Mailing Address - Country:US
Mailing Address - Phone:808-793-8943
Mailing Address - Fax:808-495-0159
Practice Address - Street 1:281 MOIKE PL
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1106
Practice Address - Country:US
Practice Address - Phone:808-793-8943
Practice Address - Fax:808-495-0159
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043623207R00000X
HIMD-17813207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110223993OtherRR MEDICARE
MD4492738OtherAETNA FEE FOR SERVICE
MDP14805OtherCAREFIRST MPOS
MD1325758OtherCIGNA PIN
MD283838OtherMAMSI SPECIALISTV
MD025440OtherJHHC PROVIDER NUMBER
MD312871700Medicaid
MD691700OtherAETNA CAPITATED
MD532650-04OtherCAREFIRST MD RENDERING
MD883838OtherMAMSI PRIMARY CARE
MD7605-0044OtherCAREFIRST BLUECHOICE
F89222Medicare UPIN
MD883838OtherMAMSI PRIMARY CARE