Provider Demographics
NPI:1740394873
Name:ADAMS, ANTOINETTE D (DPM)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:D
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847
Mailing Address - Country:US
Mailing Address - Phone:434-336-9001
Mailing Address - Fax:434-336-9229
Practice Address - Street 1:137 BAKER ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1703
Practice Address - Country:US
Practice Address - Phone:434-336-9001
Practice Address - Fax:434-336-9229
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300897213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5655110001Medicare NSC
VA190000788Medicare PIN
U93152Medicare UPIN
190000788Medicare ID - Type Unspecified