Basic Information
Provider Information | |||||||||
NPI: | 1205893161 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ADAM | ||||||||
FirstName: | JAMIE | ||||||||
MiddleName: | LYNN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD, PHD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 699 E STATE ST | ||||||||
Address2: | SRHS BUSINESS OFFICE | ||||||||
City: | SHARON | ||||||||
State: | PA | ||||||||
PostalCode: | 161462057 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7249833817 | ||||||||
FaxNumber: | 7249833941 | ||||||||
Practice Location | |||||||||
Address1: | 740 E STATE ST | ||||||||
Address2: | SHARON REGIONAL HEALTH SYSTEM LAB | ||||||||
City: | SHARON | ||||||||
State: | PA | ||||||||
PostalCode: | 161463328 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7249833952 | ||||||||
FaxNumber: | 7249833941 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/26/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | MD425815 | PA | X |   | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0105X | MD425815 | PA | X |   | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
ID Information
ID | Type | State | Issuer | Description | P00259470 | 01 |   | RAILROAD MEDICARE | OTHER | 1765796 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 7938563 | 01 | PA | AETNA PPO PATHOLOGY GROUP | OTHER | 000000376940 | 01 | OH | ANTHEM BC & BS OF OHIO | OTHER | 1014152720001 | 05 | PA |   | MEDICAID | 1024665 | 01 |   | GATEWAY (GROUP NUMBER) | OTHER | 237937 | 01 |   | HEALTH AMER/HLTH ASSURANC | OTHER | 1919857 | 01 |   | CIGNA | OTHER | 250979377062 | 01 |   | CONSUMERS LIFE PATH GROUP | OTHER | 2620177 | 05 | OH |   | MEDICAID | 3409529 | 01 |   | AETNA HMO PATHOLOGY GROUP | OTHER |