Provider Demographics
NPI:1477583920
Name:KRESHON, JAMES MARTIN JR (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARTIN
Last Name:KRESHON
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 FREEPORT ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238
Mailing Address - Country:US
Mailing Address - Phone:412-828-4409
Mailing Address - Fax:412-828-4647
Practice Address - Street 1:2585 FREEPORT ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238
Practice Address - Country:US
Practice Address - Phone:412-828-4409
Practice Address - Fax:412-828-4647
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010251L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018463020001Medicaid
PA046620Medicare ID - Type Unspecified
PA0018463020001Medicaid