Healthcare Provider Details

I. General information

NPI: 1477580876
Provider Name (Legal Business Name): MARK E ADLEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 W CAMINO REAL SUITE 206
BOCA RATON FL
33433-5512
US

IV. Provider business mailing address

7300 W CAMINO REAL SUITE 206
BOCA RATON FL
33433-5512
US

V. Phone/Fax

Practice location:
  • Phone: 561-299-9994
  • Fax: 866-587-8241
Mailing address:
  • Phone: 561-299-9994
  • Fax: 866-587-8241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS-002947L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27575
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberOS9102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: