Healthcare Provider Details

I. General information

NPI: 1073605572
Provider Name (Legal Business Name): RICHARD ADAM GOLDWASSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 REDWOOD HIGHWAY #261
MILL VALLEY CA
94941-3011
US

IV. Provider business mailing address

655 REDWOOD HIGHWAY #261
MILL VALLEY CA
94941-3011
US

V. Phone/Fax

Practice location:
  • Phone: 415-381-1690
  • Fax: 415-381-1699
Mailing address:
  • Phone: 415-381-1690
  • Fax: 415-381-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG68426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: