Healthcare Provider Details

I. General information

NPI: 1548404643
Provider Name (Legal Business Name): ADAM KENNETH CLOUD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE GENERAL SURGERY DEPT.
FARMINGTON CT
06030-6227
US

IV. Provider business mailing address

263 FARMINGTON AVE PROVIDER ENROLLMENT
FARMINGTON CT
06030-2212
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-8080
  • Fax: 860-679-1420
Mailing address:
  • Phone: 860-679-7503
  • Fax: 860-679-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number049789
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number01086536A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: