MEDICARE: DR. JAMES EDWARD WISEMAN 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	208600000X	Surgery Physician	47272	AZ
2	208600000X	Surgery Physician	D92452	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z175473	OTHER	AZ	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346421930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES EDWARD WISEMAN M.D.

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:	410-933-6423
Fax Number	:

Provider Business Practice Location Address
First Line	:	11085 LITTLE PATUXENT PKWY STE 103
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2914
Country	:	US
Telephone Number	:	410-730-1988
Fax Number	:

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

Provider Enumeration Date	:	11/25/2007
Last Update Date	:	06/17/2022

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