1568465599 NPI number — NATHANIEL HYDE M.D.

Table of content: NATHANIEL HYDE M.D. (NPI 1568465599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568465599 NPI number — NATHANIEL HYDE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HYDE
Provider First Name:
NATHANIEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568465599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
STE 2550
Provider Business Mailing Address City Name:
BRUNSWICK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04011-2681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-373-1707
Provider Business Mailing Address Fax Number:
207-373-1467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
STE 2550
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04011-2681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-373-1707
Provider Business Practice Location Address Fax Number:
207-373-1467
Provider Enumeration Date:
05/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  012201 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 030148 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: P00176278 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 154690099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".