Provider Demographics
NPI:1407382898
Name:LAKE, ADAM JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JOHN
Last Name:LAKE
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 1:3900 BROWNING PL STE 201
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6530
Mailing Address - Country:US
Mailing Address - Phone:919-787-7125
Mailing Address - Fax:919-781-9952
Practice Address - Street 1:3900 BROWNING PL STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6530
Practice Address - Country:US
Practice Address - Phone:919-787-7125
Practice Address - Fax:919-781-9952
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC228550390200000X
NC2018-024702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty