Healthcare Provider Details

I. General information

NPI: 1700043668
Provider Name (Legal Business Name): VICTOR I ADAMOV MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COOPER PLAZA ANESTHESIOLOGY DEPARTMENT
CAMDEN NJ
08103-1489
US

IV. Provider business mailing address

1 COOPER PLZ
CAMDEN NJ
08103-1461
US

V. Phone/Fax

Practice location:
  • Phone: 856-968-7330
  • Fax: 856-968-8326
Mailing address:
  • Phone: 856-968-7330
  • Fax: 856-968-8326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number25MA08056200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD433567
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD433567
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: