Provider Demographics
NPI:1932108032
Name:JAMES, JEREMY B (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:B
Last Name:JAMES
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 1:128 ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077-1220
Mailing Address - Country:US
Mailing Address - Phone:603-895-3351
Mailing Address - Fax:
Practice Address - Street 1:128 ROUTE 27
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077-1220
Practice Address - Country:US
Practice Address - Phone:603-895-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3072765Medicaid
RE4293Medicare PIN
NH3072765Medicaid