Basic Information
| Provider Information | |||||||||
| NPI: | 1073504478 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITTERANDO | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | 7818786750 | ||||||||
| Practice Location | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | 7818786750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 12/21/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 151716 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3155331 | 05 | MA | MEDICAID | 3192872 | 01 | CIGNA | OTHER | AA202102 | 01 | HARVARD PILGRIM | OTHER | 042297845 | 01 | UNITED HEALTH CARE | OTHER | 1073504478 | 01 | NEIGHBORHOOD HEALTH PLAN | OTHER | 042297845 | 01 | HCVM/FIRST HEALTH/COVENTRY | OTHER | 042297845 | 01 | GIC/UNICARE | OTHER | 042297845 | 01 | MULTI-PLAN/PHCS | OTHER | 1073504478 | 01 | FALLON | OTHER | J17375 | 01 | MA | BCBSMA | OTHER | 015716 | 01 | TUFTS | OTHER | 015716 | 01 | TUFTS MEDICARE PREFERRED | OTHER | 042297845 | 01 | TRICARE | OTHER | 2518079 | 01 | AETNA | OTHER |