Provider Demographics
NPI:1922015643
Name:MEDNICK, ADAM SETH (MD PHD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:SETH
Last Name:MEDNICK
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 S YALE AVE STE 1210
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-4234
Mailing Address - Country:US
Mailing Address - Phone:918-888-5211
Mailing Address - Fax:
Practice Address - Street 1:328 N 2ND ST STE 301
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1353
Practice Address - Country:US
Practice Address - Phone:812-885-6850
Practice Address - Fax:812-885-6851
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH204072084N0400X
WAMD610156642084N0400X
CTCT0375012084N0400X
ORMD1967182084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
200096274OtherHEALTH CONNECTICUT
200096274OtherUNITED
9794136003OtherCIGNA
0Q3637OtherHEALTHNET
200096274OtherMEDSPAN
P2491200OtherOXFORD
010037501CT02OtherANTHEM
3223587OtherAETNA
P00080745OtherRAILROAD MEDICARE
200096274OtherPHCS
317063OtherWELLCARE
772945OtherCONNECTICARE
010037501CT02OtherANTHEM
772945OtherCONNECTICARE