Healthcare Provider Details

I. General information

NPI: 1952980161
Provider Name (Legal Business Name): ADAM J HOUSE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-2837
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-0002
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number75571
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberUO8133
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number80578
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: