Basic Information
| Provider Information | |||||||||
| NPI: | 1902837768 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | SASHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KENNISON | ||||||||
| OtherFirstName: | SASHA | ||||||||
| OtherMiddleName: | D | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 307 ROSSBURN WAY | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275168365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199664389 | ||||||||
| FaxNumber: | 9199660369 | ||||||||
| Practice Location | |||||||||
| Address1: | 4008 BURNETT WOMACK BUILDING | ||||||||
| Address2: | CAMPUS BOX 7228 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139664389 | ||||||||
| FaxNumber: | 7139660369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 12/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | M0457 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 2011-01153 | NC | Y | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 2011-01153 | NC | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | 8U9383 | 01 | TX | BCBS | OTHER |