Provider Demographics
NPI:1003062449
Name:ADAM M. MECINSKI M.D. LLC
Entity Type:Organization
Organization Name:ADAM M. MECINSKI M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:MECINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-662-1522
Mailing Address - Street 1:3025 ARBOR SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6806
Mailing Address - Country:US
Mailing Address - Phone:301-662-1522
Mailing Address - Fax:301-662-4011
Practice Address - Street 1:81 THOMAS JOHNSON CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4348
Practice Address - Country:US
Practice Address - Phone:301-620-4200
Practice Address - Fax:301-662-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057777174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH46431Medicare UPIN
MD552SMedicare PIN