Provider Demographics
NPI:1669670584
Name:TYSON, ADAM THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:THOMAS
Last Name:TYSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3640 MAIN ST
Mailing Address - Street 2:STE 103
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1139
Mailing Address - Country:US
Mailing Address - Phone:413-785-5321
Mailing Address - Fax:413-731-7130
Practice Address - Street 1:3640 MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1145
Practice Address - Country:US
Practice Address - Phone:413-785-5321
Practice Address - Fax:413-731-7130
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2017-08-07
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Provider Licenses
StateLicense IDTaxonomies
MA251039208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM11346Medicare UPIN