Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | D0042053 | MD |
N | 111NI0900X | Internist | D0042053 | MD |
N | 208D00000X | General Practice Physician | 25568 | WV |
Y | 208D00000X | General Practice Physician | D0042053 | MD |
NPI | 1053310078 |
---|---|
Provider Name | Dr. James B. Deren |
First Address | Cumberland, MD 21501-1671 |
Second Address | Cumberland, MD 21502-4331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 14/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0044030000 | (05) | WV |
080100953 | TRAVELERS MEDICARE (01) | MD |
53450104 | CAREFIRST BC BS (01) | MD |
751321600 | (05) | MD |
F27746 | (02) | |
K029 0001 | BLUE CHOICE (01) | DC |