Healthcare Provider Details

I. General information

NPI: 1720052509
Provider Name (Legal Business Name): JAMES JOHN CUBEDDU PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 WHITE MOUNTAIN HIGHWAY
TAMWORTH NH
03886-4631
US

IV. Provider business mailing address

PO BOX 234 TAMWORTH FAMILY MEDICINE
WEST OSSIPEE NH
03890-0234
US

V. Phone/Fax

Practice location:
  • Phone: 603-323-3311
  • Fax: 603-323-9305
Mailing address:
  • Phone: 603-323-3311
  • Fax: 603-323-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0213P
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: