Provider Demographics
NPI:1689797151
Name:AMBERSON, JAMES BURNS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BURNS
Last Name:AMBERSON
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 1:18 TUBBS SPRING CT
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06883-1412
Mailing Address - Country:US
Mailing Address - Phone:203-454-0510
Mailing Address - Fax:203-454-0510
Practice Address - Street 1:200 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-7127
Practice Address - Country:US
Practice Address - Phone:203-381-4058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030028207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology