Provider Demographics
NPI:1417997719
Name:DALZELL, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DALZELL
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 1:411 NEW RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1648
Mailing Address - Country:US
Mailing Address - Phone:609-383-6033
Mailing Address - Fax:609-383-1548
Practice Address - Street 1:801 NEW RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1610
Practice Address - Country:US
Practice Address - Phone:609-407-5055
Practice Address - Fax:609-407-5056
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA057768002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ073854OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER
NJ4654852OtherAETNA - TRADITIONAL
NJ0157757000OtherAMERIHEALTH
NJ2231822OtherUSHC
NJ223424577OtherCIGNA
NJ1169660OtherHORIZON MERCY
NJ1884846OtherAETNA - HMO
NJ5335302Medicaid
PA0157757000OtherIBC/KHPE
NJP2043548OtherOXFORD
NJ1169660OtherHORIZON MERCY
NJ223424577OtherCIGNA
NJ5335302Medicaid