MEDICARE: DR. ADAM F NIEDELMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	047082	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	047082	OTHER	CT	CT LICENSE

General Provider Information

NPI Number	:	1316963655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM F NIEDELMAN MD

Provider Business Mailing Address
First Line	:	79 WAWECUS ST
Second Line	:
City	:	NORWICH
State	:	CT
Zip	:	06360-2160
Country	:	US
Telephone Number	:	860-886-2679
Fax Number	:	860-889-2862

Provider Business Practice Location Address
First Line	:	100 PERKINS FARM DR STE 301
Second Line	:
City	:	MYSTIC
State	:	CT
Zip	:	06355-4041
Country	:	US
Telephone Number	:	860-572-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	03/12/2020

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