Provider Demographics
NPI:1922015643
Name:MEDNICK, ADAM SETH (MD PHD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:SETH
Last Name:MEDNICK
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 JENNIFER DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2040
Mailing Address - Country:US
Mailing Address - Phone:203-671-9782
Mailing Address - Fax:
Practice Address - Street 1:58 JENNIFER DR
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2040
Practice Address - Country:US
Practice Address - Phone:203-671-9782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT0375012084N0400X
ORMD1967182084N0400X
NH204072084N0400X
WAMD610156642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
317063OtherWELLCARE
3223587OtherAETNA
200096274OtherPHCS
200096274OtherUNITED
010037501CT02OtherANTHEM
200096274OtherHEALTH CONNECTICUT
200096274OtherMEDSPAN
P2491200OtherOXFORD
P00080745OtherRAILROAD MEDICARE
9794136003OtherCIGNA
772945OtherCONNECTICARE
0Q3637OtherHEALTHNET
010037501CT02OtherANTHEM
772945OtherCONNECTICARE