Provider Demographics
NPI:1710088265
Name:ADAMS, JERRY (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7356
Mailing Address - Country:US
Mailing Address - Phone:301-729-9475
Mailing Address - Fax:301-729-9474
Practice Address - Street 1:957 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7356
Practice Address - Country:US
Practice Address - Phone:301-729-9475
Practice Address - Fax:301-729-9474
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD39811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD080119966OtherRAILROAD MEDICARE
MDP00704228Medicare PIN
MDE66115Medicare UPIN
MD142123Y1ZMedicare PIN
MD080119966OtherRAILROAD MEDICARE