Provider Demographics
NPI:1073605572
Name:GOLDWASSER, RICHARD ADAM (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ADAM
Last Name:GOLDWASSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:655 REDWOOD HIGHWAY
Mailing Address - Street 2:#261
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3011
Mailing Address - Country:US
Mailing Address - Phone:415-381-1690
Mailing Address - Fax:415-381-1699
Practice Address - Street 1:655 REDWOOD HIGHWAY
Practice Address - Street 2:#261
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3011
Practice Address - Country:US
Practice Address - Phone:415-381-1690
Practice Address - Fax:415-381-1699
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG684262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G68426OtherWORKERS COMP
CA00G684260Medicaid
CA00G684260Medicaid
F66801Medicare UPIN