Provider Demographics
NPI:1609962745
Name:MEAD, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MEAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-1229
Mailing Address - Country:US
Mailing Address - Phone:585-922-1122
Mailing Address - Fax:585-922-2664
Practice Address - Street 1:490 RIDGE RD E
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-1229
Practice Address - Country:US
Practice Address - Phone:585-922-1122
Practice Address - Fax:585-922-2664
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2240562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02281056Medicaid
MDH111OtherPREFERRED CARE
P030224056OtherEXCELLUS
3160OtherBLUE SHIELD
H63378Medicare UPIN
NY02281056Medicaid