Provider Demographics
NPI:1023014974
Name:LAW, ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:LAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 N CAYUGA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4219
Mailing Address - Country:US
Mailing Address - Phone:607-277-0969
Mailing Address - Fax:607-277-3242
Practice Address - Street 1:404 N CAYUGA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4219
Practice Address - Country:US
Practice Address - Phone:607-277-0969
Practice Address - Fax:607-277-3242
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187756-1207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2734852Medicaid
NY888009123OtherEXCELLUS
NY968698OtherMVP
NY01332970Medicaid
NY1088OtherTOTAL CARE GROUP
NY6591OtherTOTAL CARE
NY6591OtherTOTAL CARE
NY1088OtherTOTAL CARE GROUP