Provider Demographics
NPI:1619963998
Name:NATHAN, DAVID LEVI (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEVI
Last Name:NATHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8244 E US HIGHWAY 36
Mailing Address - Street 2:SUITE 1220
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9613
Mailing Address - Country:US
Mailing Address - Phone:317-272-1366
Mailing Address - Fax:317-272-1388
Practice Address - Street 1:8244 E US HIGHWAY 36
Practice Address - Street 2:SUITE 1220
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9613
Practice Address - Country:US
Practice Address - Phone:317-272-1366
Practice Address - Fax:317-272-1388
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2007-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01051097207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G77381Medicare UPIN
144610AMedicare PIN