Provider Demographics
NPI:1366610065
Name:JAMES M BACOS MD PA
Entity type:Organization
Organization Name:JAMES M BACOS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:BACOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-652-5771
Mailing Address - Street 1:1201 SEVEN LOCKS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2931
Mailing Address - Country:US
Mailing Address - Phone:301-652-5771
Mailing Address - Fax:301-652-6332
Practice Address - Street 1:18109 PRINCE PHILIP DR
Practice Address - Street 2:SUITE 225
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1519
Practice Address - Country:US
Practice Address - Phone:301-774-5810
Practice Address - Fax:301-774-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0006501207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC642726Medicare PIN