Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC-007794L | PA |
Y | 213ER0200X | Radiology | DC-007794L | PA |
NPI | 1104830330 |
---|---|
Provider Name | Dr. Bill Adams |
First Address | Erie, PA 16509-7718 |
Second Address | Erie, PA 16509-7718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0019504270002 | (05) | PA |
1038321 | ASHN/CAPITAL BLUE CROSS (01) | PA |
2574808 | AETNA (01) | PA |
433012ADA | UNITED HEALTHCARE (01) | PA |
AD916544 | BLUE SHIELD (01) | PA |
U89208 | (02) | PA |