Provider Demographics
NPI:1629239413
Name:KISTER, NATHANIEL LLOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:LLOYD
Last Name:KISTER
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3100 MACCORKLE SEAVE 301
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1229
Mailing Address - Country:US
Mailing Address - Phone:304-388-5395
Mailing Address - Fax:304-388-5398
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 301
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-388-5395
Practice Address - Fax:304-388-5398
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV28368208G00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)