Provider Demographics
NPI:1639866072
Name:OUDERKIRK, ADAM MATTHEW
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:MATTHEW
Last Name:OUDERKIRK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CHOWDERMARCH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2062
Mailing Address - Country:US
Mailing Address - Phone:339-832-0011
Mailing Address - Fax:
Practice Address - Street 1:35 CHOWDERMARCH ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2062
Practice Address - Country:US
Practice Address - Phone:339-832-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2281839363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health