Provider Demographics
NPI:1124002167
Name:STREET, JAMES ARTHUR (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ARTHUR
Last Name:STREET
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WINTERBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1574
Mailing Address - Country:US
Mailing Address - Phone:781-275-5997
Mailing Address - Fax:
Practice Address - Street 1:133 OLD ROAD TO 9 ACRE COR
Practice Address - Street 2:EMERSON HOSPITAL
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4159
Practice Address - Country:US
Practice Address - Phone:978-287-3162
Practice Address - Fax:978-287-3508
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71834207L00000X
FLME 63244207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASTJ10258OtherBC/BS OF MA
MA050050845OtherUNITED HEALTHCARE
MA3069117Medicaid
MA61969OtherFALLON COM HEALTH PLAN
MA0018584OtherNEIGHBORHOOD HEALTH PLAN
MA071834OtherTUFTS HEALTH PLAN
MA2300OtherHPHC
MA2300OtherHPHC