1619951373 NPI number — DR. MICHELLE S NATHAN MD

Table of content: DR. MICHELLE S NATHAN MD (NPI 1619951373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619951373 NPI number — DR. MICHELLE S NATHAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NATHAN
Provider First Name:
MICHELLE
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEYEDZADETH
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619951373
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 ALUMNI DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXETER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03833-2128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-580-6793
Provider Business Mailing Address Fax Number:
603-580-7006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 ALUMNI DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EXETER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03833-2128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-580-6793
Provider Business Practice Location Address Fax Number:
603-580-7006
Provider Enumeration Date:
12/05/2005

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: 207P00000X , with the licence number:  ME91979 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 14892 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01511 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1619951373 . This is a "ANTHEM BCBS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 110085918A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271519800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30209704 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 435943599 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA182828 . This is a "HPHC" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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