Healthcare Provider Details

I. General information

NPI: 1275519142
Provider Name (Legal Business Name): MARC T. ADAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 BARD AVE
STATEN ISLAND NY
10310-1666
US

IV. Provider business mailing address

360 BARD AVE
STATEN ISLAND NY
10310-1666
US

V. Phone/Fax

Practice location:
  • Phone: 718-876-2000
  • Fax: 718-876-2006
Mailing address:
  • Phone: 718-876-2000
  • Fax: 718-876-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number184817
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: