Provider Demographics
NPI:1275707721
Name:IANNUCCI, JAMES G (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:IANNUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:24 OSBORN LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-4528
Mailing Address - Country:US
Mailing Address - Phone:856-455-8745
Mailing Address - Fax:856-451-6675
Practice Address - Street 1:24 OSBORN LN
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-4528
Practice Address - Country:US
Practice Address - Phone:856-455-8745
Practice Address - Fax:856-451-6675
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA019173207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C52651Medicare UPIN
IA29333Medicare PIN