Provider Demographics
NPI:1073687216
Name:BANCROFT, JAMES ALAN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALAN
Last Name:BANCROFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 YORKTOWN PLZ
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1424
Mailing Address - Country:US
Mailing Address - Phone:215-600-4590
Mailing Address - Fax:
Practice Address - Street 1:1601 WHITEHORSE MERCERVILLE RD STE 5
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3836
Practice Address - Country:US
Practice Address - Phone:609-631-3122
Practice Address - Fax:609-666-0530
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA69799207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8701008Medicaid
NJ8700800OtherMEDICAID GROUP NUMBER
NJ223815764OtherTAX ID NUMBER
NJH45737Medicare UPIN
NJ050186Medicare ID - Type UnspecifiedMEDICARE