Active NPI
Adrian Medina, DDS
- Dentist
- Baltimore, MD
National Provider Identifier
1720412042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 16177
- Practice address
- 1501 Division St
Baltimore, MD 21217-3121 - Phone
- (410) 383-8300
- NPI assigned
- Aug 22, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 16177 | MD | Primary |
Addresses
Primary practice location
1501 Division St
Baltimore, MD 21217-3121
Mailing address
10 Ponderosa LN
Old Bridge, NJ 08857-3332
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057653 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469232000000",
"number": "1720412042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 PONDEROSA LN",
"city": "OLD BRIDGE",
"state": "NJ",
"postal_code": "088573332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 DIVISION ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212173121",
"telephone_number": "410-383-8300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "ADRIAN",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-08-22",
"last_updated": "2016-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "16177",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.