MEDICARE: JAMES SCOTT WREDE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	158481	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	158481	OTHER	MA	TUFTS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	68929	OTHER	MA	HPHC
4	J21133	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1023190634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES SCOTT WREDE D.O.

Provider Business Mailing Address
First Line	:	109 COUNTY RD # A
Second Line	:
City	:	NORTH FALMOUTH
State	:	MA
Zip	:	02556-2019
Country	:	US
Telephone Number	:	508-564-6262
Fax Number	:	508-564-6204

Provider Business Practice Location Address
First Line	:	109 COUNTY RD # A
Second Line	:
City	:	NORTH FALMOUTH
State	:	MA
Zip	:	02556-2019
Country	:	US
Telephone Number	:	508-564-6262
Fax Number	:	508-564-6204

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	03/07/2023

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