MEDICARE: MR. DONNELL I JAMES JR. P.A.

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	363A00000X	Physician Assistant	T0004306	MD
2	363A00000X	Physician Assistant	C04306	MD

General Provider Information

NPI Number	:	1407163439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONNELL I JAMES JR. P.A.

Provider Business Mailing Address
First Line	:	6190 GEORGETOWN BLVD STE 104
Second Line	:
City	:	ELDERSBURG
State	:	MD
Zip	:	21784-6460
Country	:	US
Telephone Number	:	410-552-5050
Fax Number	:	410-552-0200

Provider Business Practice Location Address
First Line	:	10084 REISTERSTOWN RD STE 200A
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-4096
Country	:	US
Telephone Number	:	410-552-5050
Fax Number	:	410-552-0200

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

Provider Enumeration Date	:	09/13/2010
Last Update Date	:	03/09/2022

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Directions to “ MR. DONNELL I JAMES JR. P.A.” Practice Location

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