Provider Demographics
NPI:1437125671
Name:NOVAK, BRAD (MD)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 RALSTON AVE
Mailing Address - Street 2:BUILDING E, SUITE C
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1960
Mailing Address - Country:US
Mailing Address - Phone:650-591-2345
Mailing Address - Fax:650-594-9299
Practice Address - Street 1:1301 RALSTON AVE
Practice Address - Street 2:BUILDING E, SUITE C
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-1960
Practice Address - Country:US
Practice Address - Phone:650-591-2345
Practice Address - Fax:650-594-9299
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA767412084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI23008Medicare UPIN