Provider Demographics
NPI:1134201205
Name:ADAMS, MARY ABBY (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ABBY
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:DIVISION OF NEONATOLOGY, WALGREEN BLDG RM 1505
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-2033
Mailing Address - Fax:847-570-0231
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:DIVISION OF NEONATOLOGY, WALGREEN BLDG RM 1505
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-2033
Practice Address - Fax:847-570-0231
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036054765208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1620385OtherBLUE SHIELD
IL036054765Medicaid
ILT38516Medicare UPIN