Provider Demographics
NPI:1457353088
Name:DAMICO, JAMES CHARLES (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CHARLES
Last Name:DAMICO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDFORD LEAS
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2254
Mailing Address - Country:US
Mailing Address - Phone:609-654-3427
Mailing Address - Fax:609-654-5519
Practice Address - Street 1:1 MEDFORD LEAS
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2254
Practice Address - Country:US
Practice Address - Phone:609-654-3427
Practice Address - Fax:609-654-5519
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB64490207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7597703Medicaid
NJ527292OtherMEDICARE ID
NJ7597703Medicaid