Healthcare Provider Details

I. General information

NPI: 1053310078
Provider Name (Legal Business Name): JAMES B. DEREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 12/02/2025
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W INDUSTRIAL BLVD
CUMBERLAND MD
21502-4331
US

IV. Provider business mailing address

PO BOX 1671
CUMBERLAND MD
21501-1671
US

V. Phone/Fax

Practice location:
  • Phone: 240-964-9355
  • Fax: 240-964-9356
Mailing address:
  • Phone: 240-964-8342
  • Fax: 240-964-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0042053
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25568
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0042053
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: