Provider Demographics
NPI:1962499087
Name:SCANLAN, JAMES GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GEORGE
Last Name:SCANLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4201 LAKE BOONE TRL STE 104
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7511
Mailing Address - Country:US
Mailing Address - Phone:919-881-0160
Mailing Address - Fax:919-881-0887
Practice Address - Street 1:4201 LAKE BOONE TRL
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7512
Practice Address - Country:US
Practice Address - Phone:919-881-0160
Practice Address - Fax:919-881-0887
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC024289207RC0000X
NC24289207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC060000080OtherRAILROAD MEDICARE
NC8974730Medicaid
NC8974730Medicaid