Provider Demographics
NPI:1548240773
Name:REDKA, JAMES WILSON (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILSON
Last Name:REDKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:1205 RIVER AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3724
Practice Address - Country:US
Practice Address - Phone:570-326-4118
Practice Address - Fax:570-326-5533
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019269E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006326330001Medicaid
PA066011Medicare PIN
PAB34750Medicare UPIN
PA232175463OtherAETNA
PA232175463OtherAMERIHEALTH
PA080022909OtherPALMETTO/MC RAILROAD
PA10593-C241OtherGEISINGER
PA002481OtherFIRST PRIORITY HEALTH
PA066011D6YMedicare PIN