Healthcare Provider Details

I. General information

NPI: 1982818480
Provider Name (Legal Business Name): NIKHIL DANIEL MAJUMDAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 3RD ST STE A
SAN RAFAEL CA
94901-3580
US

IV. Provider business mailing address

64 MARIE ST
SAUSALITO CA
94965-1864
US

V. Phone/Fax

Practice location:
  • Phone: 415-612-1908
  • Fax: 415-612-1909
Mailing address:
  • Phone: 650-273-6042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number4301095166
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberA116593
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301095166
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA116593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: