MEDICARE: ADAM DOUGLAS GLADSTONE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	158773	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	J21732	OTHER	BLUE CROSS BLUE SHEILD
2	0406652	OTHER	UNITED HEALTH CARE
3	69869	OTHER	HARVARD PILGRIM HEALTH CA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	B10418301	OTHER	CIGNA
6	158773	OTHER	TUFTS HEALTH PLAN ID

General Provider Information

NPI Number	:	1437187283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM DOUGLAS GLADSTONE M.D.

Provider Business Mailing Address
First Line	:	2110 DORCHESTER AVE
Second Line	:	#203
City	:	DORCHESTER CENTER
State	:	MA
Zip	:	02124-5628
Country	:	US
Telephone Number	:	617-296-4951
Fax Number	:	617-298-7389

Provider Business Practice Location Address
First Line	:	2110 DORCHESTER AVE
Second Line	:	#203
City	:	DORCHESTER CENTER
State	:	MA
Zip	:	02124-5628
Country	:	US
Telephone Number	:	617-296-4951
Fax Number	:	617-298-7389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/08/2007

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Directions to “ ADAM DOUGLAS GLADSTONE M.D.” Practice Location

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