Provider Demographics
NPI:1861473415
Name:SECHERESIU, ADRIAN (MD)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:SECHERESIU
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3331
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:500 1ST ST
Practice Address - Street 2:
Practice Address - City:WEATHERLY
Practice Address - State:PA
Practice Address - Zip Code:18255-1506
Practice Address - Country:US
Practice Address - Phone:570-427-8643
Practice Address - Fax:570-427-8044
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 06 1594 S207R00000X
PAMD042955L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002254OtherFIRST PRIORITY HEALTH
PA0014048480004Medicaid
PA001404848-0005Medicaid
PA0000695289OtherBLUE SHIELD
PA0014048480004Medicaid