Provider Demographics
NPI:1124053483
Name:ADELMAN, MARA (PHYSICIANS ASST PA)
Entity type:Individual
Prefix:MS
First Name:MARA
Middle Name:
Last Name:ADELMAN
Suffix:
Gender:F
Credentials:PHYSICIANS ASST PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 PEAR TREE LN
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6484
Mailing Address - Country:US
Mailing Address - Phone:707-254-1770
Mailing Address - Fax:707-254-1779
Practice Address - Street 1:1141 PEAR TREE LN
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558
Practice Address - Country:US
Practice Address - Phone:707-254-1774
Practice Address - Fax:707-251-2988
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17260363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DPA172600OtherPPIN
Q24101Medicare UPIN