Provider Demographics
NPI:1619951373
Name:NATHAN, MICHELLE S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:S
Last Name:NATHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:S
Other - Last Name:SEYEDZADETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 ALUMNI DR
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2128
Mailing Address - Country:US
Mailing Address - Phone:603-580-6793
Mailing Address - Fax:603-580-7006
Practice Address - Street 1:5 ALUMNI DR
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2128
Practice Address - Country:US
Practice Address - Phone:603-580-6793
Practice Address - Fax:603-580-7006
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91979207P00000X
NH14892207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01511OtherBCBS
NH1619951373OtherANTHEM BCBS
MA110085918AMedicaid
FL271519800Medicaid
NH30209704Medicaid
ME435943599Medicaid
NHAA182828OtherHPHC
NH001675901Medicare PIN
NH30209704Medicaid
NHAA182828OtherHPHC