Provider Demographics
NPI:1851366017
Name:ADAMSON, JENNIFER JO (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JO
Last Name:ADAMSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4784 E EDDY DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1136
Mailing Address - Country:US
Mailing Address - Phone:716-754-4607
Mailing Address - Fax:
Practice Address - Street 1:3003 9TH ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-1931
Practice Address - Country:US
Practice Address - Phone:716-284-8919
Practice Address - Fax:716-284-0428
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229948-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02574798Medicaid
NY000527933001OtherCOMMUNITY BLUE
NY0112705OtherIHA
NY041116000053OtherFIDELIS
NY00026999601OtherUNIVERA
NYI17588Medicare UPIN