Provider Demographics
NPI:1386619203
Name:WHARTON, JAMES ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:WHARTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13802 LAKE POINT CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4219
Mailing Address - Country:US
Mailing Address - Phone:502-245-4450
Mailing Address - Fax:502-245-4462
Practice Address - Street 1:13802 LAKE POINT CIR STE 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4219
Practice Address - Country:US
Practice Address - Phone:502-245-4450
Practice Address - Fax:502-245-4462
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0888207ND0900X
KY40543207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012446900Medicaid
FLHX090ZMedicare PIN