Healthcare Provider Details

I. General information

NPI: 1053982314
Provider Name (Legal Business Name): KEVIN ADIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LACKAWANNA AVE
SCRANTON PA
18503-2001
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-3823
  • Fax: 570-207-5988
Mailing address:
  • Phone: 570-961-3823
  • Fax: 570-207-5988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD496339
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: