Provider Demographics
NPI:1063532182
Name:CLEVELAND, JAMES WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:CLEVELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 TOWN CENTER PKWY # 314
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3219
Mailing Address - Country:US
Mailing Address - Phone:703-481-5212
Mailing Address - Fax:
Practice Address - Street 1:1850 TOWN CENTER PKWY # 314
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3219
Practice Address - Country:US
Practice Address - Phone:703-481-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA200459OtherBC BS PROVIDER NUMBER
VA200459OtherBC BS PROVIDER NUMBER
574264Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE