Provider Demographics
NPI:1558568857
Name:DECKARD, NATHAN ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ALLEN
Last Name:DECKARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7231 HANOVER PKWY
Mailing Address - Street 2:STE B
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2027
Mailing Address - Country:US
Mailing Address - Phone:561-445-8066
Mailing Address - Fax:
Practice Address - Street 1:1800 DUAL HWY STE 303
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6648
Practice Address - Country:US
Practice Address - Phone:301-739-0400
Practice Address - Fax:301-739-0402
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090482207Y00000X
MDD86276207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology