Provider Demographics
NPI:1407163439
Name:JAMES, DONNELL I JR (PA)
Entity Type:Individual
Prefix:MR
First Name:DONNELL
Middle Name:I
Last Name:JAMES
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6190 GEORGETOWN BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6460
Mailing Address - Country:US
Mailing Address - Phone:410-552-5050
Mailing Address - Fax:410-552-0200
Practice Address - Street 1:10084 REISTERSTOWN RD STE 200A
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4096
Practice Address - Country:US
Practice Address - Phone:410-552-5050
Practice Address - Fax:410-552-0200
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT0004306363A00000X
MDC04306363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant