Healthcare Provider Details

I. General information

NPI: 1912981929
Provider Name (Legal Business Name): JAMES P AMERENA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9093 RIDGEFIELD DR SUITE 104
FREDERICK MD
21701-6710
US

IV. Provider business mailing address

610 SOLAREX CT
FREDERICK MD
21703-8624
US

V. Phone/Fax

Practice location:
  • Phone: 301-682-4100
  • Fax: 301-682-9100
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0036421
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: