Basic Information
| Provider Information | |||||||||
| NPI: | 1184687493 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DREESE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | CHRISTIAAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64134 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104486332 | ||||||||
| FaxNumber: | 4104486296 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 KERNAN DR | ||||||||
| Address2: | SUITE 1154 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212076665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104486332 | ||||||||
| FaxNumber: | 4104486296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2006 | ||||||||
| LastUpdateDate: | 01/12/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | D63510 | MD | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | D0063510 | MD | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1184687493 | 01 | MD | NPI | OTHER | 409117500 | 05 | MD | MEDICAID |