Provider Demographics
NPI:1629078431
Name:RADOLINSKI, ADAM (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:RADOLINSKI
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3999 NASHVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-6555
Mailing Address - Country:US
Mailing Address - Phone:716-984-4591
Mailing Address - Fax:
Practice Address - Street 1:3999 NASHVILLE HWY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-6555
Practice Address - Country:US
Practice Address - Phone:716-984-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151288208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1401420OtherINDEPENDENT HEALTH ASSOC.
NY007301OtherBLUE SHIELD
NY5007301OtherBLUE CROSS
NY7177COtherCOMMUNITY BLUE
NY7177COtherCOMMUNITY BLUE
NYB71072Medicare UPIN
NY00898215Medicaid