Provider Demographics
NPI:1275528572
Name:MARVIN, ADAM H (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:H
Last Name:MARVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:350 30TH STREET
Mailing Address - Street 2:SUITE 444
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3426
Mailing Address - Country:US
Mailing Address - Phone:510-452-9213
Mailing Address - Fax:510-452-1505
Practice Address - Street 1:350 30TH STREET
Practice Address - Street 2:SUITE 444
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3426
Practice Address - Country:US
Practice Address - Phone:510-452-9213
Practice Address - Fax:510-452-1505
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA25669207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
A24527Medicare UPIN
CA00A256690Medicare ID - Type Unspecified