Healthcare Provider Details

I. General information

NPI: 1760500474
Provider Name (Legal Business Name): DAVID THOMAS ADAMS RPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ST LAWRENCE AVE
HAMMOND NY
13646-3259
US

IV. Provider business mailing address

225 ST LAWRENCE AVE
HAMMOND NY
13646-3259
US

V. Phone/Fax

Practice location:
  • Phone: 315-324-5941
  • Fax: 315-324-6414
Mailing address:
  • Phone: 315-324-5941
  • Fax: 315-324-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002017
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: