Provider Demographics
NPI:1114932829
Name:ADAJAR, MARIE JULIETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:JULIETTE
Last Name:ADAJAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:123 N MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1148
Mailing Address - Country:US
Mailing Address - Phone:570-474-5209
Mailing Address - Fax:570-474-5208
Practice Address - Street 1:123 N MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1148
Practice Address - Country:US
Practice Address - Phone:570-474-5209
Practice Address - Fax:570-474-5208
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine