Healthcare Provider Details

I. General information

NPI: 1932173341
Provider Name (Legal Business Name): MARK DAVID ADELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 JAMES ST STE 100B
SYRACUSE NY
13203-2642
US

IV. Provider business mailing address

770 JAMES ST STE 100B
SYRACUSE NY
13203-2642
US

V. Phone/Fax

Practice location:
  • Phone: 315-423-4222
  • Fax: 315-423-0305
Mailing address:
  • Phone: 315-423-4222
  • Fax: 315-423-0305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number161388
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number161388
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number161388
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: