Provider Demographics
NPI:1811002884
Name:JAMES C WASSON MD PC
Entity Type:Organization
Organization Name:JAMES C WASSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:WASSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-746-1860
Mailing Address - Street 1:122 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2051
Mailing Address - Country:US
Mailing Address - Phone:610-746-1860
Mailing Address - Fax:610-746-5068
Practice Address - Street 1:122 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-2051
Practice Address - Country:US
Practice Address - Phone:610-746-1860
Practice Address - Fax:610-746-5068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056581L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000234P2TOtherMEDICARE GROUP NUMBER
PA050971Medicare PIN