Healthcare Provider Details

I. General information

NPI: 1154398600
Provider Name (Legal Business Name): MR. JAMES EDWARD BUCCIARELLI
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N BEACON ST
WATERTOWN MA
02472-2751
US

IV. Provider business mailing address

3 MERRITT DR
HUDSON MA
01749-1775
US

V. Phone/Fax

Practice location:
  • Phone: 617-926-8720
  • Fax: 617-926-8920
Mailing address:
  • Phone: 978-562-5070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number459
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number5
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: