Provider Demographics
NPI:1497914600
Name:STILLMAN, NATHANIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:STILLMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-2726
Mailing Address - Country:US
Mailing Address - Phone:781-335-9438
Mailing Address - Fax:
Practice Address - Street 1:42 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2726
Practice Address - Country:US
Practice Address - Phone:781-335-9438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP295363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical