=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801081096
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES JOSEPH DRISCOLL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2007
-----------------------------------------------------
Last Update Date | 09/11/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8901 WISCONSIN AVE- NNMC BLDG8; THIRD FLOOR
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20889-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-435-5360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 629 MOUNT VERNON RD
-----------------------------------------------------
City | CHEEKTOWAGA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14215-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-474-4940
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | D66440
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------