Provider Demographics
NPI:1982126934
Name:ADAMS, KYLE EDWARD (PA)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:EDWARD
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:KYLE
Other - Middle Name:EDWARD
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:22 CHESTNUT PL APT 608
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7589
Mailing Address - Country:US
Mailing Address - Phone:860-235-4989
Mailing Address - Fax:
Practice Address - Street 1:85 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8200
Practice Address - Country:US
Practice Address - Phone:860-235-4989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3873363A00000X
NY021211363A00000X
MAPA7179363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1982126934Medicaid