Healthcare Provider Details

I. General information

NPI: 1912796368
Provider Name (Legal Business Name): ADAM BLACKMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/02/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN FRANCISCO PREVENTIVE MEDICAL GROUP 380 W PORTAL AVENUE, SUITE C
SAN FRANCISCO CA
94127
US

IV. Provider business mailing address

180 UNIVERSITY AVENUE SUITE 3909
TORONTO ONTARIO
M5H0A2
CA

V. Phone/Fax

Practice location:
  • Phone: 415-566-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number184251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: