Provider Demographics
NPI:1295015667
Name:ADAMS, RICHARD WARREN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WARREN
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5026
Mailing Address - Country:US
Mailing Address - Phone:401-751-1235
Mailing Address - Fax:401-751-4744
Practice Address - Street 1:1056 HOPE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5026
Practice Address - Country:US
Practice Address - Phone:401-751-1235
Practice Address - Fax:401-751-4744
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1589363A00000X
RIPA00671363A00000X
UT7875501-1206363A00000X
IA002194363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant