1902848120 NPI number — DR. NEIL H ADELMAN M.D

Table of content: DR. NEIL H ADELMAN M.D (NPI 1902848120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902848120 NPI number — DR. NEIL H ADELMAN M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADELMAN
Provider First Name:
NEIL
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1902848120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6367
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TYLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75711-6367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-509-4100
Provider Business Mailing Address Fax Number:
903-526-7440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AZALEA INTERNAL MEDICINE. PA.
Provider Second Line Business Practice Location Address:
3200 TROUP HWY SUITE 240
Provider Business Practice Location Address City Name:
TYLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75701-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-509-4100
Provider Business Practice Location Address Fax Number:
903-526-7440
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  J8194 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 88Y138 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 136860714 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 136860704 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110133049 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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