Provider Demographics
NPI:1124032230
Name:NELSON, ADAM PHILLIP (MD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:PHILLIP
Last Name:NELSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:145 CORTE MADERA TOWN CTR
Mailing Address - Street 2:PMB 594
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1209
Mailing Address - Country:US
Mailing Address - Phone:415-460-6710
Mailing Address - Fax:415-460-6710
Practice Address - Street 1:45 CAMINO ALTO
Practice Address - Street 2:SUITE 200
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2929
Practice Address - Country:US
Practice Address - Phone:415-460-6710
Practice Address - Fax:415-460-6710
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-10-04
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Provider Licenses
StateLicense IDTaxonomies
CAG688582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G688581Medicaid
CAF56462Medicare UPIN
CA00G688580Medicare PIN