Provider Demographics
NPI:1194048991
Name:KNUDSEN, JAMES FREDERICK (PHD, MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FREDERICK
Last Name:KNUDSEN
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-0421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 LAFAYETTE ST
Practice Address - Street 2:421
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1518
Practice Address - Country:US
Practice Address - Phone:207-454-0053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine