Provider Demographics
NPI:1386653210
Name:RICELY, JAMES C (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:RICELY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:6565 N CHARLES ST
Mailing Address - Street 2:SUITE 615
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6800
Mailing Address - Country:US
Mailing Address - Phone:410-339-7910
Mailing Address - Fax:410-296-7924
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:SUITE 615
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:410-339-7910
Practice Address - Fax:410-296-7924
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDH0018792207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD72295Medicare UPIN
MDK368W615Medicare ID - Type Unspecified