Basic Information
Provider Information
NPI: 1255906723
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADAMS
FirstName: MORGAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 801 ALBANY STREET
Address2: FL GROUND
City: BOSTON
State: MA
PostalCode: 02119
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 725 ALBANY STREET
Address2: SHAPIRO 3, SUITE A
City: BOSTON
State: MA
PostalCode: 02118
CountryCode: US
TelephoneNumber: 6174144861
FaxNumber: 6174143617
Other Information
ProviderEnumerationDate: 05/26/2021
LastUpdateDate: 10/26/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/12/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X  N Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363A00000XPA8161MAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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