Provider Demographics
NPI:1043202450
Name:ADAMS, MARK C (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:ADAMS
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 1:1225 CAMPBELL WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3351
Mailing Address - Country:US
Mailing Address - Phone:360-479-4203
Mailing Address - Fax:360-478-7240
Practice Address - Street 1:1225 CAMPBELL WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3351
Practice Address - Country:US
Practice Address - Phone:360-479-4203
Practice Address - Fax:360-478-7240
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000195572086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Not Answered208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91110658904OtherKPS
WA1014067Medicaid
WAAD0732OtherREGENCE
WA0011459OtherL AND I
A03947Medicare UPIN