Provider Demographics
NPI:1073707949
Name:ADAMS, CHARLES R (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
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 1:109 N 15TH ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3666
Mailing Address - Country:US
Mailing Address - Phone:402-371-0226
Mailing Address - Fax:
Practice Address - Street 1:109 N 15TH ST
Practice Address - Street 2:SUITE 14
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3666
Practice Address - Country:US
Practice Address - Phone:402-371-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE163222084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEB67884Medicare UPIN