Provider Demographics
NPI:1437143310
Name:NATHAN, HENRY P (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:P
Last Name:NATHAN
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 1:600 HOSPITAL DR STE 9
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8046
Mailing Address - Country:US
Mailing Address - Phone:828-452-0331
Mailing Address - Fax:828-456-6100
Practice Address - Street 1:600 HOSPITAL DR
Practice Address - Street 2:SUITE 9
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8046
Practice Address - Country:US
Practice Address - Phone:828-452-0331
Practice Address - Fax:828-456-8726
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22791207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2970702OtherUNITE HEALTHCARE
NC8961896Medicaid
NC61896OtherBLUE CROSS
C85707Medicare UPIN
NC209123AMedicare ID - Type Unspecified