Healthcare Provider Details

I. General information

NPI: 1629006028
Provider Name (Legal Business Name): ALBERT W ADAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 S MAIN ST
BREWER ME
04412-2322
US

IV. Provider business mailing address

399 S MAIN ST
BREWER ME
04412-2322
US

V. Phone/Fax

Practice location:
  • Phone: 207-989-9821
  • Fax: 207-989-9822
Mailing address:
  • Phone: 207-989-9821
  • Fax: 207-989-9822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number014557
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier317070000
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer
# 2
Identifier098677
Identifier TypeOTHER
Identifier StateME
Identifier IssuerBLUE SHIELD
# 3
Identifier0193422
Identifier TypeOTHER
Identifier StateME
Identifier IssuerCIGNA
# 4
Identifier5376617
Identifier TypeOTHER
Identifier StateME
Identifier IssuerAETNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: