Provider Demographics
NPI:1326095480
Name:PRATTA, JAMES A (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:PRATTA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6301 BISHOPS VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3458
Mailing Address - Country:US
Mailing Address - Phone:215-518-3130
Mailing Address - Fax:
Practice Address - Street 1:101 CARNIE BLVD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1548
Practice Address - Country:US
Practice Address - Phone:856-325-5060
Practice Address - Fax:856-325-3197
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMP00097400363A00000X
PAMA051568363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q02451Medicare UPIN
084449Medicare ID - Type Unspecified