Provider Demographics
NPI:1518160837
Name:JAMES SCOTT WREDE, D.O., LLC
Entity Type:Organization
Organization Name:JAMES SCOTT WREDE, D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WREDE
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:508-564-6262
Mailing Address - Street 1:109A COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02556-2019
Mailing Address - Country:US
Mailing Address - Phone:508-564-6262
Mailing Address - Fax:508-564-6204
Practice Address - Street 1:109A COUNTY RD
Practice Address - Street 2:
Practice Address - City:NORTH FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02556-2019
Practice Address - Country:US
Practice Address - Phone:508-564-6262
Practice Address - Fax:508-564-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158481204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA68929OtherHPHC
MA158481OtherTUFTS
MAJ21133OtherBCBS
MA3196321Medicaid
MA3196321Medicaid