MEDICARE: THE IV MEDICAL DOCTOR, P.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1447782149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE IV MEDICAL DOCTOR, P.C

Provider Business Mailing Address
First Line	:	53 W 36TH ST
Second Line	:	SUITE 204
City	:	NEW YORK
State	:	NY
Zip	:	10018-7903
Country	:	US
Telephone Number	:	844-843-4836
Fax Number	:

Provider Business Practice Location Address
First Line	:	11400 W OLYMPIC BLVD
Second Line	:	SUITE 212
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1550
Country	:	US
Telephone Number	:	844-843-4836
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. ADAM NADELSON
Credential	:	M.D.
Telephone Number	:	844-843-4836

Provider Enumeration Date	:	03/31/2017
Last Update Date	:	03/31/2017

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