Provider Demographics
NPI:1114121456
Name:MILLARD, NATHAN EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:EDWARD
Last Name:MILLARD
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 1:4262 OLD WILLIAM PENN HWY STE 208
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1954
Mailing Address - Country:US
Mailing Address - Phone:724-325-2133
Mailing Address - Fax:724-733-2278
Practice Address - Street 1:4262 OLD WILLIAM PENN HWY STE 208
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1954
Practice Address - Country:US
Practice Address - Phone:724-325-2133
Practice Address - Fax:724-733-2278
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD608344612080P0207X
PAMD458606208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology