Healthcare Provider Details

I. General information

NPI: 1700883535
Provider Name (Legal Business Name): JOSEPH F ADOLPH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 UNION ST
MARLBORO MA
01752-1274
US

IV. Provider business mailing address

340 MAIN ST STE. 670
WORCESTER MA
01608-1604
US

V. Phone/Fax

Practice location:
  • Phone: 508-481-0246
  • Fax: 508-229-0949
Mailing address:
  • Phone: 508-754-3566
  • Fax: 508-798-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number39240
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: