Provider Demographics
NPI:1588646616
Name:VALIN, NATHANIEL L (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:L
Last Name:VALIN
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 1:305 MEMORIAL MEDICAL PARKWAY, SUITE 301, SUITE 301
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-677-6672
Mailing Address - Fax:386-586-5422
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 301
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5157
Practice Address - Country:US
Practice Address - Phone:386-677-6672
Practice Address - Fax:386-586-5422
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032799207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001327990Medicaid
F64892Medicare UPIN
CT060001283Medicare ID - Type Unspecified
CT060001782Medicare PIN