Provider Demographics
NPI:1750733309
Name:DOUGLAS, ADAM (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 W MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2579
Mailing Address - Country:US
Mailing Address - Phone:732-294-2540
Mailing Address - Fax:732-409-2621
Practice Address - Street 1:1001 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2579
Practice Address - Country:US
Practice Address - Phone:732-294-2540
Practice Address - Fax:732-409-2621
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA10649400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine