Provider Demographics
NPI:1578652517
Name:NATHAN, DAVID LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LAWRENCE
Last Name:NATHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 PRINCESS RD
Mailing Address - Street 2:SUITE #207
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2322
Mailing Address - Country:US
Mailing Address - Phone:609-243-0445
Mailing Address - Fax:609-844-1092
Practice Address - Street 1:601 EWING ST
Practice Address - Street 2:SUITE C-10
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2757
Practice Address - Country:US
Practice Address - Phone:609-688-0400
Practice Address - Fax:609-688-0401
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA671282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG31418Medicare UPIN
NJ011044Medicare ID - Type Unspecified