Provider Demographics
NPI:1609050756
Name:PRUETT, ADAM J (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:J
Last Name:PRUETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05254-0255
Mailing Address - Country:US
Mailing Address - Phone:802-768-9136
Mailing Address - Fax:802-662-2173
Practice Address - Street 1:4384 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05254-8945
Practice Address - Country:US
Practice Address - Phone:802-768-9136
Practice Address - Fax:802-662-2173
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0598632084P0800X
AL285842084P0800X
VT042.00139992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry