Provider Demographics
NPI:1689780132
Name:MUCINSKAS, ADAM PAUL (DPM)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:PAUL
Last Name:MUCINSKAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 WEST ST STE K
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-4405
Mailing Address - Country:US
Mailing Address - Phone:860-632-5499
Mailing Address - Fax:860-632-5515
Practice Address - Street 1:162 WEST ST STE K
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-4405
Practice Address - Country:US
Practice Address - Phone:860-632-5499
Practice Address - Fax:860-632-5515
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000768335E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT480000963Medicare ID - Type Unspecified
CTU95630Medicare UPIN