Provider Demographics
NPI:1811934797
Name:NEVITT, ADAM WERLEY (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:WERLEY
Last Name:NEVITT
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:P.O. BOX 6102
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-6102
Mailing Address - Country:US
Mailing Address - Phone:415-884-3418
Mailing Address - Fax:
Practice Address - Street 1:1900 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2200
Practice Address - Country:US
Practice Address - Phone:650-991-6503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA680492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1811934797Medicaid
CA00A680490Medicaid
CA300121785OtherRAILROAD MEDICARE
CADG573PMedicare PIN
NVDG573QMedicare PIN
CA00A680491Medicare PIN
NV1811934797Medicaid
NVEM093YMedicare PIN
CADG573OMedicare PIN
CA00A680496Medicare PIN
CADG573WMedicare PIN
CADG537NMedicare PIN
CA300121785OtherRAILROAD MEDICARE
CADG573SMedicare PIN
CADG573UMedicare PIN
NVDG573RMedicare PIN
CADG573TMedicare PIN
CADG573XMedicare PIN
CA00A680497Medicare PIN
CADG573VMedicare PIN