Provider Demographics
NPI:1568422665
Name:ADOLPH, CARL M (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:M
Last Name:ADOLPH
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 1:170 N POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4132
Mailing Address - Country:US
Mailing Address - Phone:717-299-4871
Mailing Address - Fax:717-391-2494
Practice Address - Street 1:170 N POINTE BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4132
Practice Address - Country:US
Practice Address - Phone:717-299-4871
Practice Address - Fax:717-391-2494
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072648L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA950004OtherBLUE SHIELD
PA0015164320005Medicaid
PA1140698OtherAMERIHEALTHMERCY
PA136291OtherHEALTHAMERICA/HEALTHASSUR
PA200042473OtherRAILROAD MEDICARE
PA02208801OtherBLUE CROSS
PA2513087OtherAETNA
PA2513087OtherAETNA
PAAD046750Medicare ID - Type Unspecified