Provider Demographics
NPI:1477915106
Name:MEHOLICK, ADRIANA L (MD)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:L
Last Name:MEHOLICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2505
Mailing Address - Country:US
Mailing Address - Phone:781-453-7740
Mailing Address - Fax:781-453-7710
Practice Address - Street 1:148 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2505
Practice Address - Country:US
Practice Address - Phone:781-453-7740
Practice Address - Fax:781-453-7710
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10959200390200000X
MA294554208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program