Provider Demographics
NPI:1023190634
Name:WREDE, JAMES SCOTT (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:SCOTT
Last Name:WREDE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 COUNTY RD # A
Mailing Address - Street 2:
Mailing Address - City:NORTH FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02556-2019
Mailing Address - Country:US
Mailing Address - Phone:508-564-6262
Mailing Address - Fax:508-564-6204
Practice Address - Street 1:109 COUNTY RD # A
Practice Address - Street 2:
Practice Address - City:NORTH FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02556-2019
Practice Address - Country:US
Practice Address - Phone:508-564-6262
Practice Address - Fax:508-564-6204
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158481204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA158481OtherTUFTS
MA3196321Medicaid
MA68929OtherHPHC
MAJ21133OtherBCBS
MAJ21133OtherBCBS
MA3196321Medicaid
MA68929OtherHPHC