Provider Demographics
NPI:1275880882
Name:NEVINS, DONALD B (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:B
Last Name:NEVINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 TAMAL VISTA BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1127
Mailing Address - Country:US
Mailing Address - Phone:415-927-1497
Mailing Address - Fax:415-381-9590
Practice Address - Street 1:21 TAMAL VISTA BLVD STE 212
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1127
Practice Address - Country:US
Practice Address - Phone:415-927-1497
Practice Address - Fax:415-381-9590
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG-159252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G159250Medicare PIN
CAA39660Medicare UPIN