Provider Demographics
NPI:1841340080
Name:ADAIR, MARY L (PA)
Entity type:Individual
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First Name:MARY
Middle Name:L
Last Name:ADAIR
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Gender:F
Credentials:PA
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Mailing Address - Street 1:8390 CHAMPIONS GATE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8310
Mailing Address - Country:US
Mailing Address - Phone:407-390-1677
Mailing Address - Fax:407-390-1765
Practice Address - Street 1:4940 VAN NUYS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-380-2626
Practice Address - Fax:818-380-2620
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2018-08-14
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Provider Licenses
StateLicense IDTaxonomies
CAPA13410363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS57346Medicare UPIN