Provider Demographics
NPI:1568465599
Name:HYDE, NATHANIEL (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:HYDE
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 1:121 MEDICAL CENTER DR
Mailing Address - Street 2:STE 2550
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2681
Mailing Address - Country:US
Mailing Address - Phone:207-373-1707
Mailing Address - Fax:207-373-1467
Practice Address - Street 1:121 MEDICAL CENTER DR
Practice Address - Street 2:STE 2550
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2681
Practice Address - Country:US
Practice Address - Phone:207-373-1707
Practice Address - Fax:207-373-1467
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME012201208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME154690099Medicaid
MEP00176278OtherRAILROAD MEDICARE
ME030148OtherANTHEM
MEP00176278OtherRAILROAD MEDICARE
ME030148OtherANTHEM