Provider Demographics
NPI:1679783609
Name:RUSSELL, LATONYA DEMETRIA (MD, MPH)
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:DEMETRIA
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:LATONYA
Other - Middle Name:DEMETRIA
Other - Last Name:RUSSELL MESSERSCHMITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:1950 GLENN MITCHELL DR
Mailing Address - Street 2:STE 310
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0019
Mailing Address - Country:US
Mailing Address - Phone:757-507-0402
Mailing Address - Fax:757-507-3171
Practice Address - Street 1:1800 CAMELOT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2440
Practice Address - Country:US
Practice Address - Phone:757-491-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245930208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics