Provider Demographics
NPI:1184687493
Name:DREESE, JAMES CHRISTIAAN (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CHRISTIAAN
Last Name:DREESE
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:PO BOX 64134
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4134
Mailing Address - Country:US
Mailing Address - Phone:410-448-6332
Mailing Address - Fax:410-448-6296
Practice Address - Street 1:2200 KERNAN DR
Practice Address - Street 2:SUITE 1154
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-6665
Practice Address - Country:US
Practice Address - Phone:410-448-6332
Practice Address - Fax:410-448-6296
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD63510207X00000X
MDD0063510207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1184687493OtherNPI
MD409117500Medicaid
MDM861Medicare PIN
DCU02Medicare PIN
MDP00286642Medicare PIN
MD1184687493OtherNPI