Provider Demographics
NPI:1275504094
Name:DOE, NATHANIEL S (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:S
Last Name:DOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1340 BELMONT AVE
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1125
Mailing Address - Country:US
Mailing Address - Phone:330-746-1488
Mailing Address - Fax:330-746-5611
Practice Address - Street 1:1340 BELMONT AVE
Practice Address - Street 2:SUITE 2300
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1125
Practice Address - Country:US
Practice Address - Phone:330-746-1488
Practice Address - Fax:330-746-5611
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063443D207RN0300X
PAMD056504L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01537577Medicaid
OH979919Medicaid
OHDO0784102Medicare ID - Type Unspecified
OHF79307Medicare UPIN
OH979919Medicaid