Healthcare Provider Details

I. General information

NPI: 1831486554
Provider Name (Legal Business Name): JAMES MICHAEL MEDEIROS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 BROOKLEY AVE SW BLDG 1300
BOLLING AFB DC
20032-7704
US

IV. Provider business mailing address

238 BROOKLEY AVE SW BLDG 1300
BOLLING AFB DC
20032-7704
US

V. Phone/Fax

Practice location:
  • Phone: 855-227-6331
  • Fax:
Mailing address:
  • Phone: 855-227-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberOS016249
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberOS016249
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS016249
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: