Healthcare Provider Details

I. General information

NPI: 1396872685
Provider Name (Legal Business Name): JAMES R WHARTON MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13802 LAKE POINT CIR STE 102
LOUISVILLE KY
40223-4219
US

IV. Provider business mailing address

13802 LAKE POINT CIR STE 102
LOUISVILLE KY
40223-4219
US

V. Phone/Fax

Practice location:
  • Phone: 502-245-4450
  • Fax: 502-245-4462
Mailing address:
  • Phone: 502-245-4450
  • Fax: 502-245-4462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES ROBERT WHARTON
Title or Position: SOLE DIRECTOR AND OFFICER
Credential: M.D.
Phone: 502-245-4450