Basic Information
| Provider Information | |||||||||
| NPI: | 1770585663 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAMES | ||||||||
| FirstName: | A DAVID | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5308 HARROUN RD | ||||||||
| Address2: | STE 155 | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198246100 | ||||||||
| FaxNumber: | 4198417735 | ||||||||
| Practice Location | |||||||||
| Address1: | 5308 HARROUN RD | ||||||||
| Address2: | STE 155 | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198246100 | ||||||||
| FaxNumber: | 4198417735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 05/01/2012 | ||||||||
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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 | 207R00000X | 35062900 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 35062900 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 04-02985 | 01 | OH | UHC | OTHER | 000000141250 | 01 | OH | ANTHEM | OTHER | 01486 | 01 | OH | PARAMOUNT | OTHER | 0915933 | 05 | OH | MEDICAID | 11068 | 01 | OH | HPM | OTHER | 0635936 | 01 | OH | AETNA | OTHER | 110176071 | 01 | OH | RRMC | OTHER |