Provider Demographics
NPI:1003901273
Name:MAXWELL, JAMES T (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:MAXWELL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 670
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-342-7170
Mailing Address - Fax:585-342-5855
Practice Address - Street 1:1445 PORTLAND AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3036
Practice Address - Country:US
Practice Address - Phone:585-342-7170
Practice Address - Fax:585-342-5855
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-03-22
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Provider Licenses
StateLicense IDTaxonomies
NY137227207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00684184Medicaid
B75305Medicare UPIN
NY00684184Medicaid
J400000087Medicare PIN