MEDICARE: JAMES SCOTT WREDE, D.O., LLC

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	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	158481	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68929	OTHER	MA	HPHC
2	158481	OTHER	MA	TUFTS
3	J21133	OTHER	MA	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518160837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES SCOTT WREDE, D.O., LLC

Provider Business Mailing Address
First Line	:	109A COUNTY RD
Second Line	:
City	:	NORTH FALMOUTH
State	:	MA
Zip	:	02556-2019
Country	:	US
Telephone Number	:	508-564-6262
Fax Number	:	508-564-6204

Provider Business Practice Location Address
First Line	:	109A COUNTY RD
Second Line	:
City	:	NORTH FALMOUTH
State	:	MA
Zip	:	02556-2019
Country	:	US
Telephone Number	:	508-564-6262
Fax Number	:	508-564-6204

Authorized Official
Title or Position	:	PRESIDENT PHYSICIAN
Name	:	DR. JAMES SCOTT WREDE
Credential	:	D. O.
Telephone Number	:	508-564-6262

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	12/30/2008

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