Healthcare Provider Details

I. General information

NPI: 1831216282
Provider Name (Legal Business Name): COREY ANDREW PRIESMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY 3RD FLOOR
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

2001 DWIGHT WAY, STE 4190
BERKELEY CA
94704-2608
US

V. Phone/Fax

Practice location:
  • Phone: 510-843-2220
  • Fax:
Mailing address:
  • Phone: 415-515-7294
  • Fax: 510-843-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA90340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: