Provider Demographics
NPI:1467442533
Name:OLSEN, ADAM R (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:R
Last Name:OLSEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:112 QUARRY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4816
Mailing Address - Country:US
Mailing Address - Phone:203-333-8800
Mailing Address - Fax:203-333-6054
Practice Address - Street 1:112 QUARRY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4816
Practice Address - Country:US
Practice Address - Phone:203-333-8800
Practice Address - Fax:203-333-6054
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001463363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ19727Medicare UPIN
CT970001942Medicare ID - Type Unspecified