Provider Demographics
NPI:1730181025
Name:ADAM, DAVID R (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:ADAM
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:P.O. BOX 631662
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1662
Mailing Address - Country:US
Mailing Address - Phone:859-581-7120
Mailing Address - Fax:859-581-7207
Practice Address - Street 1:1017 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1605
Practice Address - Country:US
Practice Address - Phone:513-868-2181
Practice Address - Fax:513-868-2893
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.050113207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100332970Medicaid
180026252OtherMEDICARE RAILROAD
OH0574918Medicaid
OH0604665Medicare PIN
OH0604667Medicare PIN
180026252OtherMEDICARE RAILROAD
OHA17101Medicare UPIN