Provider Demographics
NPI:1972712016
Name:PLEISTER, ADAM PAUL (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:PAUL
Last Name:PLEISTER
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 1:4975 BRADENTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3521
Mailing Address - Country:US
Mailing Address - Phone:614-766-0773
Mailing Address - Fax:614-766-2599
Practice Address - Street 1:4975 BRADENTON AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017
Practice Address - Country:US
Practice Address - Phone:614-766-0773
Practice Address - Fax:614-766-2599
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35093819207R00000X, 207RS0012X
OH35.093819207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2963440Medicaid
OH2963440Medicaid