Basic Information
Provider Information
NPI: 1720042831
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRUMBLE
FirstName: JAMES
MiddleName: BLAKE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 E CARROLL ST
Address2:  
City: SALISBURY
State: MD
PostalCode: 218015422
CountryCode: US
TelephoneNumber: 4105466400
FaxNumber:  
Practice Location
Address1: 145 E CARROLL ST # 101102
Address2:  
City: SALISBURY
State: MD
PostalCode: 218015454
CountryCode: US
TelephoneNumber: 4109125785
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/14/2006
LastUpdateDate: 10/05/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/05/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XD0058210MDY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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