Basic Information
| Provider Information | |||||||||
| NPI: | 1912940131 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADELMAN | ||||||||
| FirstName: | JUDD | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2671 ELMS PLANTATION BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294069165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437976800 | ||||||||
| FaxNumber: | 8437976825 | ||||||||
| Practice Location | |||||||||
| Address1: | 2671 ELMS PLANTATION BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294069165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437976800 | ||||||||
| FaxNumber: | 8437976825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 11/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 23930 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 23930 | 01 | SC | LIC | OTHER | 20-23930 | 01 | SC | SC CONTROLLED SUBSTANCE | OTHER | BA6092097 | 01 | DEA | OTHER |