Provider Demographics
NPI:1679583587
Name:SCHUB, RUSSELL OWEN (DO)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:OWEN
Last Name:SCHUB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8875 CENTRE PARK DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2114
Mailing Address - Country:US
Mailing Address - Phone:410-730-1000
Mailing Address - Fax:410-730-8615
Practice Address - Street 1:8875 CENTRE PARK DR
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2114
Practice Address - Country:US
Practice Address - Phone:410-730-1000
Practice Address - Fax:410-730-8615
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH35058207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD526471500Medicaid
E37085Medicare UPIN
8338Medicare PIN
130423YLZMedicare PIN
DN9254Medicare PIN
100004444Medicare PIN
P00646386Medicare PIN
130249Medicare PIN