MEDICARE: ADAM J JARCZEWSKI MEDICAL DOCTOR INC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	A82540	CA

General Provider Information

NPI Number	:	1932383577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAM J JARCZEWSKI MEDICAL DOCTOR INC

Provider Business Mailing Address
First Line	:	2055 WOODSIDE RD.,
Second Line	:	SUITE 155
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-3355
Country	:	US
Telephone Number	:	650-364-4200
Fax Number	:	650-364-4210

Provider Business Practice Location Address
First Line	:	2055 WOODSIDE RD.,
Second Line	:	SUITE 155
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-3355
Country	:	US
Telephone Number	:	650-364-4200
Fax Number	:	650-364-4210

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ADAM J. JARCZEWSKI
Credential	:	M.D.
Telephone Number	:	650-521-6014

Provider Enumeration Date	:	12/18/2007
Last Update Date	:	11/16/2010

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