Provider Demographics
NPI:1184625238
Name:ADLEBERG, JAMES STEPHEN (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEPHEN
Last Name:ADLEBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 SANDPIPER CIR STE 104
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5028
Mailing Address - Country:US
Mailing Address - Phone:410-933-3300
Mailing Address - Fax:410-933-3303
Practice Address - Street 1:8100 SANDPIPER CIR
Practice Address - Street 2:STE 104
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5028
Practice Address - Country:US
Practice Address - Phone:410-933-3300
Practice Address - Fax:410-933-3303
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01012213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409083700Medicaid
MD480025235OtherRAILROAD MEDICARE
MDCK4820OtherMEDICARE RAILROAD
MDLV09OtherCAREFIRST
MD1231180001Medicare NSC
MD040MMedicare ID - Type Unspecified
MDT89027Medicare UPIN
MD409083700Medicaid
MDCK4820Medicare PIN
MD040MMedicare PIN