Provider Demographics
NPI:1477580876
Name:ADLEN, MARK E (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:ADLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 W CAMINO REAL
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5512
Mailing Address - Country:US
Mailing Address - Phone:561-299-9994
Mailing Address - Fax:866-587-8241
Practice Address - Street 1:7300 W CAMINO REAL
Practice Address - Street 2:SUITE 206
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5512
Practice Address - Country:US
Practice Address - Phone:561-299-9994
Practice Address - Fax:866-587-8241
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-002947L207Q00000X
NJ27575207Q00000X
FLOS91022084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2074940OtherAETNA
PA0006166850001Medicaid
PA0734967002OtherCIGNA HEALTHCARE
PABUP007OtherOXFORD
PA053319OtherHIGHMARK BCBS
NJ4900308Medicaid
PA0022623000OtherKEYSTONE HEALTH PLAN EAST
PA0022623000OtherIBC PERSONAL CHOICE
NJ053319OtherHORIZON BCBS NJ
PA1006861OtherMERCY
PA0061668506OtherAMERICHOICE
NJ053319OtherHORIZON BCBS NJ
PABUP007OtherOXFORD
PA441081605Medicare ID - Type UnspecifiedRAILROAD MEDICARE