Basic Information
Provider Information
NPI: 1639433428
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCKENZIE
FirstName: ADAM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 12248
Address2:  
City: NEW BERN
State: NC
PostalCode: 285612248
CountryCode: US
TelephoneNumber: 2525146685
FaxNumber: 2525146685
Practice Location
Address1: 702 NEWMAN RD
Address2:  
City: NEW BERN
State: NC
PostalCode: 285625238
CountryCode: US
TelephoneNumber: 2526335333
FaxNumber: 2526339443
Other Information
ProviderEnumerationDate: 06/27/2012
LastUpdateDate: 08/15/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X5101019781MIN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RP1001X2018-01311NCY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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