| Paul E Nicholas, MD | |
|
405 W College Ave Ste F, Santa Rosa, CA 95401-6506 | |
| (707) 547-5450 | |
| (707) 573-3555 |
| Full Name | Paul E Nicholas |
|---|---|
| Gender | Male |
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 405 W College Ave Ste F, Santa Rosa, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699861344 | NPI | - | NPPES |
| 34606500 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 47520 (Wisconsin) | Secondary |
| 2084N0400X | Psychiatry & Neurology - Neurology | A98793 (California) | Primary |
| Entity Name | Providence Medical Foundation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1285890624 PECOS PAC ID: 8921993205 Enrollment ID: O20040216001346 |
| Mailing Address | Practice Location Address |
|---|---|
| Paul E Nicholas, MD 405 W College Ave Ste F, Santa Rosa, CA 95401-6506 Ph: (707) 547-5450 | Paul E Nicholas, MD 405 W College Ave Ste F, Santa Rosa, CA 95401-6506 Ph: (707) 547-5450 |
Dr. Stevan Keram, M.D. Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 1160 N Dutton Ave, Suite 255, Santa Rosa, CA 95401 Phone: 707-526-8800 Fax: 707-526-8886 | |
Barry G Pierce, M.D. Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 1260 N Dutton Ave, Santa Rosa, CA 95401 Phone: 707-525-9045 Fax: 707-525-0426 | |
Michael Frederick Kozart, Psychiatry & Neurology Medicare: Medicare Enrolled Practice Location: 3322 Chanate Rd, Santa Rosa, CA 95404 Phone: 707-565-4970 | |
Neil P. Ehrlich, M.D. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 3322 Chanate Rd., Santa Rosa, CA 95404 Phone: 707-565-4741 | |
Dr. Robert S. Gardner, M.D. Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 525 College Ave, 211, Santa Rosa, CA 95404 Phone: 707-575-7647 Fax: 707-575-7739 | |
John F. Cassidy, MD Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 401 Bicentennial Way, Santa Rosa, CA 95403 Phone: 707-571-4000 | |
Dr. Nandini Lee Rao, MD Psychiatry & Neurology Medicare: Medicare Enrolled Practice Location: 401 Bicentennial Way, Santa Rosa, CA 95403 Phone: 707-571-3778 Fax: 707-571-3799 |