Healthcare Provider Details

I. General information

NPI: 1376962654
Provider Name (Legal Business Name): JAMES B. HENDELE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-7232
US

IV. Provider business mailing address

41 MALL ROAD LAHEY HOSPITAL AND MEDICAL CENTER
BURLINGTON MA
01805-5095
US

V. Phone/Fax

Practice location:
  • Phone: 206-520-5000
  • Fax:
Mailing address:
  • Phone: 781-744-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number290502
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD60939550
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: