Provider Demographics
NPI:1952780322
Name:WIERCINSKI, ADAM (DO)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:WIERCINSKI
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 1:405 W GRAND AVE
Mailing Address - Street 2:MEDICAL EDUCATION DEPARTMENT
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4720
Mailing Address - Country:US
Mailing Address - Phone:937-723-3245
Mailing Address - Fax:937-723-5016
Practice Address - Street 1:405 W GRAND AVE
Practice Address - Street 2:MEDICAL EDUCATION DEPARTMENT
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4720
Practice Address - Country:US
Practice Address - Phone:937-723-3245
Practice Address - Fax:937-723-5016
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.012416207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine