Provider Demographics
NPI:1629348974
Name:WANNEN, JAME KATHLEEN (MD)
Entity Type:Individual
Prefix:MRS
First Name:JAME
Middle Name:KATHLEEN
Last Name:WANNEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JAME
Other - Middle Name:KATHLEEN
Other - Last Name:HESKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:903 MADISON AVE
Mailing Address - Street 2:4F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4150
Mailing Address - Country:US
Mailing Address - Phone:212-737-9604
Mailing Address - Fax:
Practice Address - Street 1:903 MADISON AVE
Practice Address - Street 2:4F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4150
Practice Address - Country:US
Practice Address - Phone:212-737-9604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine