MEDICARE: DR. JAMES B. DEREN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D0042053	MD
2	208D00000X	General Practice Physician	25568	WV
3	208D00000X	General Practice Physician	D0042053	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080100953	OTHER	MD	TRAVELERS MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K029 0001	OTHER	DC	BLUE CHOICE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	53450104	OTHER	MD	CAREFIRST BC BS

General Provider Information

NPI Number	:	1053310078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES B. DEREN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1671
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21501-1671
Country	:	US
Telephone Number	:	240-964-8342
Fax Number	:	240-964-8337

Provider Business Practice Location Address
First Line	:	1050 W INDUSTRIAL BLVD
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-4331
Country	:	US
Telephone Number	:	240-964-9355
Fax Number	:	240-964-9356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	12/02/2025

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