Provider Demographics
NPI:1982717062
Name:ADAMS, MICHAEL DARIEN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DARIEN
Last Name:ADAMS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8971 COUNTY ROUTE 87
Mailing Address - Street 2:
Mailing Address - City:HAMMONDSPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14840-9787
Mailing Address - Country:US
Mailing Address - Phone:607-569-2124
Mailing Address - Fax:
Practice Address - Street 1:7571 STATE ROUTE 54
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-9504
Practice Address - Country:US
Practice Address - Phone:607-776-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY461638367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00461638Medicaid
NY00461638Medicaid