Provider Demographics
NPI:1588764153
Name:CONGDON, JAMES (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CONGDON
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 1:722 E BUTLER PIKE
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2310
Mailing Address - Country:US
Mailing Address - Phone:610-524-1552
Mailing Address - Fax:
Practice Address - Street 1:722 E BUTLER PIKE
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2310
Practice Address - Country:US
Practice Address - Phone:610-524-1552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022532E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010284900003Medicaid
PA830401OtherPENNSYLVANIA BLUE SHIELD
PACD9539OtherRAILROAD MEDICARE
PA147680LHBMedicare ID - Type Unspecified
PA830401OtherPENNSYLVANIA BLUE SHIELD