Provider Demographics
NPI:1811309891
Name:HETLAND, ADAM THOMAS (DO)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:THOMAS
Last Name:HETLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4624
Mailing Address - Country:US
Mailing Address - Phone:413-442-0085
Mailing Address - Fax:413-464-9143
Practice Address - Street 1:42 SUMMER ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4624
Practice Address - Country:US
Practice Address - Phone:413-442-0085
Practice Address - Fax:413-464-9143
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA271659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine