Provider Demographics
NPI:1679784003
Name:ADAMOVICH, BRENDA LYNN (DO)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LYNN
Last Name:ADAMOVICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MEDICAL PARK
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-234-5143
Mailing Address - Fax:304-243-3028
Practice Address - Street 1:10 MEDICAL PARK
Practice Address - Street 2:SUITE 301
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-234-5143
Practice Address - Fax:304-243-3028
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21862084N0400X
OH34.0101922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3111797Medicaid
WV3810019155Medicaid
OHH156971Medicare PIN