Healthcare Provider Details

I. General information

NPI: 1750733309
Provider Name (Legal Business Name): ADAM DOUGLAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W MAIN ST SUITE B
FREEHOLD NJ
07728-2579
US

IV. Provider business mailing address

1001 W MAIN ST SUITE B
FREEHOLD NJ
07728-2579
US

V. Phone/Fax

Practice location:
  • Phone: 732-294-2540
  • Fax: 732-409-2621
Mailing address:
  • Phone: 732-294-2540
  • Fax: 732-409-2621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA10649400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: