Provider Demographics
NPI:1053940049
Name:CORDUM, ADAM WALLACE (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:WALLACE
Last Name:CORDUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 604337
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-4337
Mailing Address - Country:US
Mailing Address - Phone:919-238-2000
Mailing Address - Fax:919-238-5010
Practice Address - Street 1:8300 HEALTH PARK STE 107
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4731
Practice Address - Country:US
Practice Address - Phone:919-238-2000
Practice Address - Fax:919-238-5010
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-01645207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty