Provider Demographics
NPI:1417084989
Name:CENTERS, NATHAN LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:LAWRENCE
Last Name:CENTERS
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 1:500 W 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801
Mailing Address - Country:US
Mailing Address - Phone:302-230-9192
Mailing Address - Fax:302-691-1100
Practice Address - Street 1:500 W 10TH STREET
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801
Practice Address - Country:US
Practice Address - Phone:302-230-9192
Practice Address - Fax:302-691-1100
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECI00059522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001104101Medicaid
DE0001104101Medicaid
DE617330Medicare PIN