Reno Morelly Russell, PA-C
Physician Assistant in Raleigh, NC. Individual provider (NPI-1).
NPI number1124348404
StatusActive
Last updated in NPPESApr 11, 2023
Details
- NPI
- 1124348404
- Entity type
- Individual (NPI-1)
- Name
- Reno Morelly Russell
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 9, 2010
- Certification date
- Apr 11, 2023
- Last updated
- Apr 11, 2023
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 0010-11322 | NC | Yes |
| 363A00000X | Physician Assistant | 5601005764 | MI | |
| 363A00000X | Physician Assistant | 50.004332RX | OH |
Practice location
11550 Common Oaks Dr Ste 100Raleigh, NC 27614-8093
Phone 919-453-5740 · Fax 919-453-5741
Mailing address
Po Box 5105Belfast, ME 04915-5100
Phone 919-220-5255
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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