Provider Demographics
NPI:1881663946
Name:ADLER, JEREMY P (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:P
Last Name:ADLER
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 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-449-2732
Mailing Address - Fax:765-449-1196
Practice Address - Street 1:2525 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3028
Practice Address - Country:US
Practice Address - Phone:765-807-2320
Practice Address - Fax:765-807-2330
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056311A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200271940Medicaid
INP00140459OtherRAILROAD MEDICARE
INP00140459OtherRAILROAD MEDICARE
IN815150TMedicare PIN