Robert S. Adamenko, MD
Individual provider Active NPI Pediatrics Physician · Glastonbury, CT
NPI 1629040100 · NPPES record last updated Nov 20, 2013
Key facts
- NPI
- 1629040100
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 038613 (CT)
- Practice address
- 320 Western Blvd
Suite 102
Glastonbury, CT 06033-1259 - Phone
- (860) 633-9235
- NPI assigned
- Feb 7, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040129000650 | CT | Practitioner - Pediatric Medicine | 3072416890 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Interoperability endpoints
- robert.adamenko.npi1629040100.phpct@direct.optumcare.masshiway.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 038613 | CT | Yes |
Addresses
Primary practice location
320 Western Blvd
Suite 102
Glastonbury, CT 06033-1259
Mailing address
290 Western Blvd
Glastonbury, CT 06033-1236
Phone (860) 633-9235
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001386136 | Medicaid | CT |
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All providers in Glastonbury, CT · Pediatrics Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.