Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Peter Russo

Individual provider Physician Assistant · NPI 1720627037

Peter Russo is a Physician Assistant in Gretna, Louisiana. Qualified in 2019, 7 years ago. Practices with Westside Dermatology Associates a Professional Medical Corporation, a 2-clinician group and accepts Medicare assignment.

Years since qualifying
7
In the registry since
2020
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Practice location Address checks out

120 Ochsner Blvd
Gretna, LA 70056-5255
Phone: (504) 391-7620
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1720627037
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJanuary 3, 2020
Last updated in NPPESJanuary 3, 2020
Certification dateJanuary 3, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Westside Dermatology Associates A Professional Medical Corporation — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Gretna