Provider Demographics
NPI:1740285261
Name:MENSONE, JAMES CAESAR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CAESAR
Last Name:MENSONE
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 1:10 ENTERPRISE BLVD
Mailing Address - Street 2:STE 112
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3534
Mailing Address - Country:US
Mailing Address - Phone:864-297-4093
Mailing Address - Fax:864-297-4095
Practice Address - Street 1:10 ENTERPRISE BLVD
Practice Address - Street 2:STE 112
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3534
Practice Address - Country:US
Practice Address - Phone:864-297-4093
Practice Address - Fax:864-297-4095
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2010-04-02
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
SC7427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC134290167OtherTAX ID
SC1710122239OtherBILLING NPI
SC1710122239OtherBILLING NPI
8157Medicare PIN