Provider Demographics
NPI:1376993485
Name:MAXWELL, ADAM WALTER (MD)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:WALTER
Last Name:MAXWELL
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 1:336 DEERFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607
Mailing Address - Country:US
Mailing Address - Phone:828-262-4100
Mailing Address - Fax:573-884-5690
Practice Address - Street 1:336 DEERFIELD ROAD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607
Practice Address - Country:US
Practice Address - Phone:828-262-4100
Practice Address - Fax:573-884-3037
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2022-08-17
Deactivation Date:2017-12-17
Deactivation Code:
Reactivation Date:2018-08-08
Provider Licenses
StateLicense IDTaxonomies
MO2016019175207R00000X
VA20160191752085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology