Healthcare Provider Details

I. General information

NPI: 1255331526
Provider Name (Legal Business Name): JAMES M PRIBULA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 HOSPITAL HILL RD SUITE 1600
SHARON CT
06069-2095
US

IV. Provider business mailing address

PO BOX 789
SHARON CT
06069-0789
US

V. Phone/Fax

Practice location:
  • Phone: 860-364-5585
  • Fax:
Mailing address:
  • Phone: 860-364-4471
  • Fax: 860-364-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number78208
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: