Provider Demographics
NPI:1235113911
Name:MAXWELL, JAMES HEATH (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HEATH
Last Name:MAXWELL
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 1:1317 N. ELM STREET
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1023
Mailing Address - Country:US
Mailing Address - Phone:336-274-9617
Mailing Address - Fax:336-482-2177
Practice Address - Street 1:1317 N ELM ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1023
Practice Address - Country:US
Practice Address - Phone:336-274-9617
Practice Address - Fax:336-482-2177
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC300085678OtherRAILROAD MEDICARE
NC73480OtherMEDCOST
NC24725OtherPARTNERS
NC1600274OtherUNITED HEALTHCARE
NC55108OtherBLUE CROSS BLUE SHIELD
NC8955108Medicaid
NC24725OtherPARTNERS
NCC82459Medicare UPIN