Healthcare Provider Details

I. General information

NPI: 1699000398
Provider Name (Legal Business Name): RICHARD CHARLES ADLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BLACK GOLD BLVD
HAZARD KY
41701-2620
US

IV. Provider business mailing address

210 BLACK GOLD BLVD
HAZARD KY
41701-2620
US

V. Phone/Fax

Practice location:
  • Phone: 606-436-0711
  • Fax: 606-436-0848
Mailing address:
  • Phone: 606-436-0711
  • Fax: 606-436-0848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43427
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3275
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: