Healthcare Provider Details

I. General information

NPI: 1710963145
Provider Name (Legal Business Name): JAMES CHRISTOPHER NEDEROSTEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 819 BOX 18
FPO AE
09645-0001
US

IV. Provider business mailing address

PSC 819 BOX 4638
FPO AE
09645-0047
US

V. Phone/Fax

Practice location:
  • Phone: 314-727-3403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101235181
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: