Provider Demographics
NPI:1932173341
Name:ADELSON, MARK DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:ADELSON
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 1:770 JAMES ST STE 100B
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2642
Mailing Address - Country:US
Mailing Address - Phone:315-423-4222
Mailing Address - Fax:315-423-0305
Practice Address - Street 1:770 JAMES ST STE 100B
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2642
Practice Address - Country:US
Practice Address - Phone:315-423-4222
Practice Address - Fax:315-423-0305
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161388207V00000X, 207VX0201X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00897961Medicaid
NY161427195OtherTAX IDENTIFICATION NUMBER
NY161388OtherNYS LICENSE NUMBER
NY00897961Medicaid