1548286677 NPI number — DR. JAMES SCLUCTORE AMEDEU OD

Table of content: JENS CHRISTIAN NILSON (NPI 1770262370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548286677 NPI number — DR. JAMES SCLUCTORE AMEDEU OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMEDEU
Provider First Name:
JAMES
Provider Middle Name:
SCLUCTORE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548286677
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2811 LORD BALTIMORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-316-2101
Provider Business Mailing Address Fax Number:
410-265-6068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 WEST PATRICK ST
Provider Second Line Business Practice Location Address:
UNITED OPTICAL
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-698-0303
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  MDTA0905 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)