Healthcare Provider Details

I. General information

NPI: 1720082787
Provider Name (Legal Business Name): KENNETH G. ADAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARKWAY
HAVERHILL MA
01830-6278
US

IV. Provider business mailing address

1 PARKWAY
HAVERHILL MA
01830-6278
US

V. Phone/Fax

Practice location:
  • Phone: 978-521-3270
  • Fax: 978-469-5644
Mailing address:
  • Phone: 978-521-3288
  • Fax: 978-469-5644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number49552
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: