Provider Demographics
NPI:1598068520
Name:MACKEY, JAMES HOWARD III (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:HOWARD
Last Name:MACKEY
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:610 BALTIMORE ST
Mailing Address - Street 2:POBOX 329
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21914-1103
Mailing Address - Country:US
Mailing Address - Phone:410-287-9616
Mailing Address - Fax:
Practice Address - Street 1:50 UNION ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1534
Practice Address - Country:US
Practice Address - Phone:207-664-5311
Practice Address - Fax:207-664-5305
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR138984367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered