Provider Demographics
NPI:1629020433
Name:DEMICCO, JAMES RAY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RAY
Last Name:DEMICCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 CYPRESS ST
Mailing Address - Street 2:BRIGHAM AND WOMENS PHYSICIANS ORGANIZATION
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445
Mailing Address - Country:US
Mailing Address - Phone:617-582-1200
Mailing Address - Fax:
Practice Address - Street 1:111 MORSE STREET
Practice Address - Street 2:BRIGHAM AND WOMENS AT NORWOOD
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-440-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA43000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine