Provider Demographics
NPI:1164460374
Name:DIRESTA, JAMES JOHN (DPM, MPH)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOHN
Last Name:DIRESTA
Suffix:
Gender:M
Credentials:DPM, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 1/2 FORRESTER STREET
Mailing Address - Street 2:PROFESSIONAL BUILDING
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950
Mailing Address - Country:US
Mailing Address - Phone:978-465-2122
Mailing Address - Fax:
Practice Address - Street 1:37 1/2 FORRESTER ST
Practice Address - Street 2:PROFESSIONAL BUILDING
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-1938
Practice Address - Country:US
Practice Address - Phone:978-465-2122
Practice Address - Fax:978-465-0450
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1523213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY70643OtherBLUE SHIELD
MA702862OtherTAHP
MA702862OtherTAHP
MAY70643OtherBLUE SHIELD