Healthcare Provider Details

I. General information

NPI: 1821025214
Provider Name (Legal Business Name): DEBORAH W ADNER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 FOLEY ST
SOMERVILLE MA
02145-1213
US

IV. Provider business mailing address

440 FOLEY ST
SOMERVILLE MA
02145-1213
US

V. Phone/Fax

Practice location:
  • Phone: 857-282-0777
  • Fax: 857-282-2386
Mailing address:
  • Phone: 857-282-0777
  • Fax: 857-282-2386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number950951
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number660
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: