Provider Demographics
NPI:1417921032
Name:NATELSON, ETHAN ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:ALLEN
Last Name:NATELSON
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 1:8707 WATEKA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-4015
Mailing Address - Country:US
Mailing Address - Phone:713-771-8844
Mailing Address - Fax:
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1001
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-5154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9036207RH0003X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01265010OtherRR MEDICARE
TX041934304Medicaid
TXDE4842OtherRAILROAD MEDICARE
TX041934303Medicaid
TX8V4457OtherBLUE CROSS BLUE SHIELD
TXDE4842OtherRAILROAD MEDICARE
TX8V4457OtherBLUE CROSS BLUE SHIELD
TX041934304Medicaid