Provider Demographics
NPI:1487864286
Name:OGLETREE, JAMES MICHAEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:OGLETREE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-0930
Mailing Address - Country:US
Mailing Address - Phone:703-963-0704
Mailing Address - Fax:202-782-8253
Practice Address - Street 1:6900 GEORGIA AVE NW
Practice Address - Street 2:BLDG 2, ROOM 4655 (CT SURGERY)
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0003
Practice Address - Country:US
Practice Address - Phone:202-782-3607
Practice Address - Fax:202-782-8253
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC-1500363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical