Provider Demographics
NPI:1003966870
Name:NATH, DWARKA G (M D)
Entity Type:Individual
Prefix:DR
First Name:DWARKA
Middle Name:G
Last Name:NATH
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40124 HIGHWAY 27 STE 204
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-5905
Mailing Address - Country:US
Mailing Address - Phone:863-419-2156
Mailing Address - Fax:
Practice Address - Street 1:40124 HIGHWAY 27 STE 204
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-5905
Practice Address - Country:US
Practice Address - Phone:863-419-2156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL51613207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052599500Medicaid
FL052599500Medicaid
FLE68976Medicare UPIN