Healthcare Provider Details

I. General information

NPI: 1649461401
Provider Name (Legal Business Name): TIMOTHY MARTIN ADAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 YOUNGS RD
WILLIAMSVILLE NY
14221-8053
US

IV. Provider business mailing address

1150 YOUNGS RD
WILLIAMSVILLE NY
14221-8053
US

V. Phone/Fax

Practice location:
  • Phone: 716-636-9004
  • Fax:
Mailing address:
  • Phone: 716-636-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number245531
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number245531
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: