Provider Demographics
NPI:1578884581
Name:ADAMS, MARK ANTHONY SR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:ADAMS
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:313 FEDERAL DR NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-3070
Mailing Address - Country:US
Mailing Address - Phone:812-738-4155
Mailing Address - Fax:812-738-6104
Practice Address - Street 1:313 FEDERAL DR NW
Practice Address - Street 2:SUITE 200
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-3070
Practice Address - Country:US
Practice Address - Phone:812-738-4155
Practice Address - Fax:812-738-6104
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2020-12-10
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Provider Licenses
StateLicense IDTaxonomies
SC32802207Q00000X
IN01075329A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC328024Medicaid
SC5689393OtherCIGNA
IN201290880Medicaid
IN525220002Medicare PIN
SC5689393OtherCIGNA