Provider Demographics
NPI:1235132051
Name:MARCOVITCH, ADAM JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JASON
Last Name:MARCOVITCH
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 1:507 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-5419
Mailing Address - Country:US
Mailing Address - Phone:814-237-4105
Mailing Address - Fax:
Practice Address - Street 1:507 LOCUST LN
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5419
Practice Address - Country:US
Practice Address - Phone:814-237-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400909207W00000X
PAMD429629207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913722Medicaid
NCI15227Medicare UPIN
NC8913722Medicaid