Provider Demographics
NPI:1720052509
Name:CUBEDDU, JAMES JOHN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JOHN
Last Name:CUBEDDU
Suffix:
Gender:M
Credentials:PA-C
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 234
Mailing Address - Street 2:TAMWORTH FAMILY MEDICINE
Mailing Address - City:WEST OSSIPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03890-0234
Mailing Address - Country:US
Mailing Address - Phone:603-323-3311
Mailing Address - Fax:603-323-9305
Practice Address - Street 1:577 WHITE MOUNTAIN HIGHWAY
Practice Address - Street 2:
Practice Address - City:TAMWORTH
Practice Address - State:NH
Practice Address - Zip Code:03886-4631
Practice Address - Country:US
Practice Address - Phone:603-323-3311
Practice Address - Fax:603-323-9305
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0213P363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH279611OtherCIGNA
NH30330004Medicaid
NHAP0740Medicare ID - Type Unspecified
NH30330004Medicaid