Provider Demographics
NPI:1992700504
Name:MCKENDREE, JAMES EDWARD JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:MCKENDREE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1013 MENOHER BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-2544
Mailing Address - Country:US
Mailing Address - Phone:814-254-4885
Mailing Address - Fax:814-254-4533
Practice Address - Street 1:1013 MENOHER BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2544
Practice Address - Country:US
Practice Address - Phone:814-254-4885
Practice Address - Fax:814-254-4533
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD420002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019195700003Medicaid
PAH81498Medicare UPIN
PA0019195700003Medicaid