Healthcare Provider Details

I. General information

NPI: 1710088265
Provider Name (Legal Business Name): JERRY ADAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 NATIONAL HWY
LAVALE MD
21502-7356
US

IV. Provider business mailing address

957 NATIONAL HWY
LAVALE MD
21502-7356
US

V. Phone/Fax

Practice location:
  • Phone: 301-729-9475
  • Fax: 301-729-9474
Mailing address:
  • Phone: 301-729-9475
  • Fax: 301-729-9474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD39811
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: