Healthcare Provider Details

I. General information

NPI: 1740262096
Provider Name (Legal Business Name): JAMES MARK SKOLKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL ST
SALISBURY MD
21801-5422
US

IV. Provider business mailing address

1325 MOUNT HERMON RD SUITE 14B
SALISBURY MD
21804-5259
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-7375
  • Fax:
Mailing address:
  • Phone: 410-742-4401
  • Fax: 410-742-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0040025
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: