Healthcare Provider Details

I. General information

NPI: 1982231163
Provider Name (Legal Business Name): NIALL ADAMS MB BCH BAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MEDICAL CENTER DR
BRUNSWICK ME
04011-2652
US

IV. Provider business mailing address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

V. Phone/Fax

Practice location:
  • Phone: 18-120-7729
  • Fax:
Mailing address:
  • Phone: 347-875-7020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD23840
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: