Healthcare Provider Details

I. General information

NPI: 1144498924
Provider Name (Legal Business Name): ANTOINETTE D ADAMS, DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 CHAMPIONS WAY SUITE 700 HARBOUR VIEW PROFESSIONAL CENTER, BUILDING 2
SUFFOLK VA
23435
US

IV. Provider business mailing address

PO BOX 5495
SUFFOLK VA
23435-5494
US

V. Phone/Fax

Practice location:
  • Phone: 757-686-3668
  • Fax: 757-686-3669
Mailing address:
  • Phone: 757-686-3668
  • Fax: 757-686-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103300897
License Number StateVA

VIII. Authorized Official

Name: DR. ANTOINETTE DENISE ADAMS
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 757-686-3668