Provider Demographics
NPI:1700926078
Name:ADAMS, DEAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:R
Last Name:ADAMS
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 1:6795 HILLOCK CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1173
Mailing Address - Country:US
Mailing Address - Phone:859-630-7501
Mailing Address - Fax:
Practice Address - Street 1:200 S RIVER ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1143
Practice Address - Country:US
Practice Address - Phone:570-821-1100
Practice Address - Fax:570-821-1108
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293639208600000X
KY35071208C00000X
PAMD468500208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00241227OtherRAILROAD MEDICARE
KY64530710Medicaid
IN200518330Medicaid
OH2472711Medicaid
G95089Medicare UPIN
OHP00241227OtherRAILROAD MEDICARE