Provider Demographics
NPI:1740267699
Name:CUSACK, JAMES DENNIS (DPM)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DENNIS
Last Name:CUSACK
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 1:217 MOCKSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3325
Mailing Address - Country:US
Mailing Address - Phone:704-636-7575
Mailing Address - Fax:
Practice Address - Street 1:217 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3325
Practice Address - Country:US
Practice Address - Phone:704-636-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC309213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890810JMedicaid
NC890810JMedicaid
T80549Medicare UPIN