Basic Information
| Provider Information | |||||||||
| NPI: | 1346301207 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMASTER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 307 COOPER ST | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568450256 | ||||||||
| FaxNumber: | 8568456255 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 S 54TH STREET | ||||||||
| Address2: | MERCY HOSPITAL OF PHILADELPHIA | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157489000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 07/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MB04019700 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | OS004037L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0011281730009 | 05 | PA | MEDICAID |