1205893161 NPI number — DR. JAMIE L ADAM MD, PHD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205893161 NPI number — DR. JAMIE L ADAM MD, PHD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ADAM

Provider First Name:

JAMIE

Provider Middle Name:

L

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD, PHD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1205893161

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/14/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

700 HIGH ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WILLIAMSPORT

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

17701-3100

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

570-321-3780

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

740 E STATE ST

Provider Second Line Business Practice Location Address:

SHARON REGIONAL HEALTH SYSTEM LAB

Provider Business Practice Location Address City Name:

SHARON

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

16146-3328

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

724-983-3952

Provider Business Practice Location Address Fax Number:

724-983-3941

Provider Enumeration Date:

04/26/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207ZP0105X , with the licence number:  MD425815 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207ZP0101X , with the licence number: MD425815 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1014152720001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 3409529 . This is a "AETNA HMO PATHOLOGY GROUP" identifier . This identifiers is of the category "OTHER".
• Identifier: 237937 . This is a "HEALTH AMER/HLTH ASSURANC" identifier . This identifiers is of the category "OTHER".
• Identifier: 250979377062 . This is a "CONSUMERS LIFE PATH GROUP" identifier . This identifiers is of the category "OTHER".
• Identifier: P00259470 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 1765796 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2620177 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 1024665 . This is a "GATEWAY (GROUP NUMBER)" identifier . This identifiers is of the category "OTHER".
• Identifier: 1919857 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 7938563 . This is a "AETNA PPO PATHOLOGY GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 000000376940 . This is a "ANTHEM BC & BS OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".