Provider Demographics
NPI:1073504478
Name:MITTERANDO, JAMES L (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:L
Last Name:MITTERANDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:143 LONGWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1683
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:781-878-6750
Practice Address - Street 1:143 LONGWATER DR
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1683
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:781-878-6750
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3155331Medicaid
3192872OtherCIGNA
AA202102OtherHARVARD PILGRIM
042297845OtherUNITED HEALTH CARE
1073504478OtherNEIGHBORHOOD HEALTH PLAN
042297845OtherHCVM/FIRST HEALTH/COVENTRY
042297845OtherGIC/UNICARE
042297845OtherMULTI-PLAN/PHCS
1073504478OtherFALLON
MAJ17375OtherBCBSMA
015716OtherTUFTS
015716OtherTUFTS MEDICARE PREFERRED
042297845OtherTRICARE
2518079OtherAETNA
MAJ17375OtherBCBSMA
042297845OtherTRICARE