Provider Demographics
NPI:1154490050
Name:FIDEL, ADAM MARC (DC)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MARC
Last Name:FIDEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1866 REISTERSTOWN RD # F
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1335
Mailing Address - Country:US
Mailing Address - Phone:410-484-5642
Mailing Address - Fax:410-484-5541
Practice Address - Street 1:1866 REISTERSTOWN RD # F
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1335
Practice Address - Country:US
Practice Address - Phone:410-484-5642
Practice Address - Fax:410-484-5541
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS1340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD251NOtherMEDICARE PTAN