Provider Demographics
NPI:1487865234
Name:NADERER, MARC ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:ANTHONY
Last Name:NADERER
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 1:1076 W MCPHERSON HWY
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:OH
Mailing Address - Zip Code:43410-1002
Mailing Address - Country:US
Mailing Address - Phone:419-547-0340
Mailing Address - Fax:419-547-9130
Practice Address - Street 1:1076 W MCPHERSON HWY
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-1002
Practice Address - Country:US
Practice Address - Phone:419-547-0340
Practice Address - Fax:419-547-9130
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-090068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2901953Medicaid
OH4243851Medicare PIN