Provider Demographics
NPI:1255370409
Name:ADELMAN, MARK (PA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:ADELMAN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2224 W CATALINA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-2627
Mailing Address - Country:US
Mailing Address - Phone:480-898-1596
Mailing Address - Fax:480-898-1596
Practice Address - Street 1:7436 E MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-8338
Practice Address - Country:US
Practice Address - Phone:480-983-5111
Practice Address - Fax:480-982-4686
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ1501363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical