Healthcare Provider Details

I. General information

NPI: 1881835510
Provider Name (Legal Business Name): JOHN J JAMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 GLASTONBURY BLVD STE 202
GLASTONBURY CT
06033-4456
US

IV. Provider business mailing address

55 WALLS DR STE 405
FAIRFIELD CT
06824-5163
US

V. Phone/Fax

Practice location:
  • Phone: 959-251-1770
  • Fax:
Mailing address:
  • Phone: 203-409-8415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA08745100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number252115
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number051978
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: