Provider Demographics
NPI:1689874729
Name:RICHARD A ADELMAN JR MD PA
Entity Type:Organization
Organization Name:RICHARD A ADELMAN JR MD PA
Other - Org Name:THE VEIN AND LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADELMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:850-747-8346
Mailing Address - Street 1:738 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2524
Mailing Address - Country:US
Mailing Address - Phone:850-747-8346
Mailing Address - Fax:850-747-9649
Practice Address - Street 1:738 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2524
Practice Address - Country:US
Practice Address - Phone:850-747-8346
Practice Address - Fax:850-747-9649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43574202K00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0704755OtherUNITED HEALTHCARE
FL03614OtherBLUE CROSS BLUE SHIELD
FL4278623OtherAETNA
FL0704755OtherUNITED HEALTHCARE
FLK7013Medicare PIN
FL03614OtherBLUE CROSS BLUE SHIELD