Healthcare Provider Details

I. General information

NPI: 1497956361
Provider Name (Legal Business Name): JAMES BRYSON MCCAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 KANAWHA BLVD E
CHARLESTON WV
25301-2400
US

IV. Provider business mailing address

1120 KANAWHA BLVD E
CHARLESTON WV
25301-2400
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-3457
  • Fax: 304-344-3480
Mailing address:
  • Phone: 304-344-3457
  • Fax: 304-344-3480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number22269
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number22269
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number22269
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: