Provider Demographics
NPI:1497752554
Name:ADAMS, ELVIN EUGENE (MD/MPH)
Entity Type:Individual
Prefix:DR
First Name:ELVIN
Middle Name:EUGENE
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD/MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6436
Mailing Address - Country:US
Mailing Address - Phone:910-793-4311
Mailing Address - Fax:910-793-4322
Practice Address - Street 1:1444 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6436
Practice Address - Country:US
Practice Address - Phone:910-793-4311
Practice Address - Fax:910-793-4322
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2519207R00000X
NC20993207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0831521-02OtherMEDICAID GROUP BASE #
TX00J33TOtherMEDICARE GROUP #
TX0983439-04Medicaid
TX0831497-02Medicaid
NC1497752554Medicaid
TX0983439-03Medicaid
TX0983439-04Medicaid
TX00J33TOtherMEDICARE GROUP #