Provider Demographics
NPI:1457329443
Name:CHISUM, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:CHISUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3501 SINCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2029
Mailing Address - Country:US
Mailing Address - Phone:410-732-8800
Mailing Address - Fax:410-534-2392
Practice Address - Street 1:1245 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-3422
Practice Address - Country:US
Practice Address - Phone:410-558-4700
Practice Address - Fax:410-780-0364
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-11-05
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Provider Licenses
StateLicense IDTaxonomies
MDD0041356207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F36613Medicare UPIN