Provider Demographics
NPI:1942466396
Name:WILLARD, ADRIENNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:
Last Name:WILLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:
Other - Last Name:FREIDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 CHERRY ST
Mailing Address - Street 2:SUITE 11511
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1321
Mailing Address - Country:US
Mailing Address - Phone:215-255-7822
Mailing Address - Fax:215-255-7825
Practice Address - Street 1:1427 VINE ST
Practice Address - Street 2:6TH FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1031
Practice Address - Country:US
Practice Address - Phone:215-762-6565
Practice Address - Fax:215-762-6997
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD441729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102583924Medicaid
PA218417Medicare PIN