Provider Demographics
NPI:1710085550
Name:ALDRIDGE, JAMES TIMOTHY (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TIMOTHY
Last Name:ALDRIDGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:
Other - Last Name:ALDRIDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1400 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-8931
Mailing Address - Country:US
Mailing Address - Phone:574-223-2020
Mailing Address - Fax:574-223-5847
Practice Address - Street 1:1400 E 9TH ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-8931
Practice Address - Country:US
Practice Address - Phone:574-223-2020
Practice Address - Fax:574-223-5847
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001427207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100269960BMedicaid
IN1255439022OtherMEDICARE RAILROAD
IN110207420OtherMEDICARE RAILROAD
IN100366380Medicaid
IN1255439022OtherMEDICARE RAILROAD
IN100366380Medicaid
INE36361Medicare UPIN
IN192840Medicare PIN