Provider Demographics
NPI:1780850123
Name:ADICOFF, ARNOLD (M D,)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:
Last Name:ADICOFF
Suffix:
Gender:M
Credentials:M D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13952 COLLIER RD
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9340
Mailing Address - Country:US
Mailing Address - Phone:530-477-1904
Mailing Address - Fax:530-273-1617
Practice Address - Street 1:13952 COLLIER RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-9340
Practice Address - Country:US
Practice Address - Phone:530-477-1904
Practice Address - Fax:530-273-1617
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNG4781174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA95459Medicare UPIN