Provider Demographics
NPI:1205348646
Name:SMITH, ADAM CHRISTOPHER (RN)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:CHRISTOPHER
Last Name:SMITH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 CHANDLER ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2924
Mailing Address - Country:US
Mailing Address - Phone:508-421-4344
Mailing Address - Fax:508-421-4427
Practice Address - Street 1:162 CHANDLER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2924
Practice Address - Country:US
Practice Address - Phone:508-421-4344
Practice Address - Fax:508-421-4427
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2304315163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse