Provider Demographics
NPI:1114020708
Name:MARCHAND, NATHAN RUSSO (MD)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:RUSSO
Last Name:MARCHAND
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 1:3030 NORTH ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1433
Mailing Address - Country:US
Mailing Address - Phone:409-899-2500
Mailing Address - Fax:409-898-7579
Practice Address - Street 1:3030 NORTH ST
Practice Address - Street 2:SUITE 430
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1433
Practice Address - Country:US
Practice Address - Phone:409-899-2500
Practice Address - Fax:409-898-7579
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7400208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193326901Medicaid
LA1042803Medicaid
H91473Medicare UPIN
TX8K3332Medicare PIN