Provider Demographics
NPI:1154867422
Name:TOTH, NATHAN WILLIAM (PA-C)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:WILLIAM
Last Name:TOTH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 MCCLEARY TER
Mailing Address - Street 2:APT. 406
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4542
Mailing Address - Country:US
Mailing Address - Phone:240-367-2043
Mailing Address - Fax:
Practice Address - Street 1:602 S ATWOOD RD STE 100
Practice Address - Street 2:SUITE 100
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4198
Practice Address - Country:US
Practice Address - Phone:410-638-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0006307363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical