Basic Information
| Provider Information | |||||||||
| NPI: | 1992021158 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ZEIGLER | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1735 27TH ST STE B06 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456622681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403568681 | ||||||||
| FaxNumber: | 7403537900 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 CIC BLVD | ||||||||
| Address2: | |||||||||
| City: | WEST UNION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456938024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375440981 | ||||||||
| FaxNumber: | 9375440985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2010 | ||||||||
| LastUpdateDate: | 12/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 34.010779 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics | 174400000X | 03564 | KY | N | Other Service Providers | Specialist | 174400000X | 34.010779 | OH | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 7100251540 | 05 | KY | MEDICAID | 0083598 | 05 | OH | MEDICAID |