Healthcare Provider Details

I. General information

NPI: 1295015667
Provider Name (Legal Business Name): RICHARD WARREN ADAMS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 HOPE ST
PROVIDENCE RI
02906-5026
US

IV. Provider business mailing address

1056 HOPE ST
PROVIDENCE RI
02906-5026
US

V. Phone/Fax

Practice location:
  • Phone: 401-751-1235
  • Fax: 401-751-4744
Mailing address:
  • Phone: 401-751-1235
  • Fax: 401-751-4744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1589
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00671
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7875501-1206
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002194
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: