Provider Demographics
NPI:1134126709
Name:PACE, JAMES NICHOLAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:NICHOLAS
Last Name:PACE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3017
Mailing Address - Country:US
Mailing Address - Phone:610-376-5649
Mailing Address - Fax:610-376-4194
Practice Address - Street 1:916 PENN AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3017
Practice Address - Country:US
Practice Address - Phone:610-376-5649
Practice Address - Fax:610-376-4194
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002934L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01692501OtherCAPITAL BLUE CROSS
PA176518OtherPENN. BLUE SHIELD
PA1009083Medicaid
PA4511300001Medicare NSC
PA176518OtherPENN. BLUE SHIELD