Healthcare Provider Details

I. General information

NPI: 1174536841
Provider Name (Legal Business Name): ADACHI MEDICAL ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ST. PAUL PLACE SUITE 603
BALTIMORE MD
21202-2165
US

IV. Provider business mailing address

301 ST. PAUL PLACE SUITE 603
BALTIMORE MD
21202
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-1521
  • Fax: 410-752-8495
Mailing address:
  • Phone: 410-332-1521
  • Fax: 410-752-8495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD0041017
License Number StateMD

VIII. Authorized Official

Name: DR. TARO J ADACHI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 410-332-1521