Provider Demographics
NPI:1841226727
Name:MACKESSY, JAMES P (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:MACKESSY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:PATRICK
Other - Last Name:MACKESSY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:680 BUCKLES CT N STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6927
Mailing Address - Country:US
Mailing Address - Phone:614-986-0125
Mailing Address - Fax:614-237-1646
Practice Address - Street 1:680 BUCKLES CT N STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-6927
Practice Address - Country:US
Practice Address - Phone:614-986-0125
Practice Address - Fax:614-237-1646
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.060234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0808451Medicaid
OH0808451Medicaid
OHMA0678288Medicare PIN
OH0100881OtherUNITED HEALTHCARE OF OHIO
E65502Medicare UPIN