Healthcare Provider Details

I. General information

NPI: 1942284336
Provider Name (Legal Business Name): JAMES DAVID WINES JR. MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 01/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MILL ST OAKS BLDG RM 341 MCLEAN HOSPITAL ADARC
BELMONT MA
02478-1041
US

IV. Provider business mailing address

51 SEA AVE
QUINCY MA
02169-3156
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-2769
  • Fax: 617-855-2519
Mailing address:
  • Phone: 617-855-2769
  • Fax: 617-855-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number73514
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number73514
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: