Provider Demographics
NPI:1114910643
Name:MCCULLOUGH, JAMES Y JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:Y
Last Name:MCCULLOUGH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:700 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2926
Mailing Address - Country:US
Mailing Address - Phone:812-944-6488
Mailing Address - Fax:812-944-6480
Practice Address - Street 1:700 E SPRING ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2926
Practice Address - Country:US
Practice Address - Phone:812-944-6488
Practice Address - Fax:812-944-6480
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01028772A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF61873Medicare UPIN
INMC24186Medicare ID - Type Unspecified