Provider Demographics
NPI:1669435236
Name:WASSON, JAMES C (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:WASSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:534 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2715
Mailing Address - Country:US
Mailing Address - Phone:610-746-1860
Mailing Address - Fax:610-746-5068
Practice Address - Street 1:534 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-2715
Practice Address - Country:US
Practice Address - Phone:610-746-1860
Practice Address - Fax:610-746-5068
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056581L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG54816Medicare UPIN
PA000234P2TMedicare PIN