NPI Code Detail JSON Logo

1508237660 NPI number — ADAM CHARLES WADDELL MD

NPI Number: 1508237660
Health Care Provider/Practitioner: ADAM CHARLES WADDELL MD

Information about “1508237660” NPI (ADAM CHARLES WADDELL MD) exists in 1508237660 in HTML format HTML  |  1508237660 in plain Text format TXT  |  1508237660 in PDF (Portable Document Format) PDF  |  1508237660 in an XML format XML  formats.

NPI Number : 1508237660 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1508237660",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WADDELL",
    "FirstName": "ADAM",
    "MiddleName": "CHARLES",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8900 VAN WYCK EXPY FL 5",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RICHMOND HILL",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11418-2897",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "201-675-0284",
    "MailingAddressFaxNumber": "786-672-6006",
    "FirstLinePracticeLocationAddress": "8900 VAN WYCK EXPY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RICHMOND HILL",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11418-2897",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "201-675-0284",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/15/2015",
    "LastUpdateDate": "11/26/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2084N0400X",
          "TaxonomyName": "Neurology Physician",
          "LicenseNumber": "MD227457",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084A2900X",
          "TaxonomyName": "Neurocritical Care Physician",
          "LicenseNumber": "319202",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "2084N0400X",
          "TaxonomyName": "Neurology Physician",
          "LicenseNumber": "2019-00633",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084N0400X",
          "TaxonomyName": "Neurology Physician",
          "LicenseNumber": "109381",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084N0400X",
          "TaxonomyName": "Neurology Physician",
          "LicenseNumber": "MD61624014",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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