Provider Demographics
NPI:1689601387
Name:ADAMS, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1406 W 5TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1688
Mailing Address - Country:US
Mailing Address - Phone:606-864-4137
Mailing Address - Fax:606-878-6386
Practice Address - Street 1:1406 W 5TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1688
Practice Address - Country:US
Practice Address - Phone:606-864-4137
Practice Address - Fax:606-878-6386
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY22682207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64226822Medicaid
KY64226822Medicaid
C64431Medicare UPIN