Provider Demographics
NPI:1649775552
Name:MORIARTY, NATHANIEL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:THOMAS
Last Name:MORIARTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NATHAN
Other - Middle Name:THOMAS
Other - Last Name:MORIARTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1130 W. MICHIGAN ST
Mailing Address - Street 2:FESLER HALL 204
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-274-4343
Mailing Address - Fax:317-274-0256
Practice Address - Street 1:1130 W. MICHIGAN ST
Practice Address - Street 2:FESLER HALL 204
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-274-4343
Practice Address - Fax:317-274-0256
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-24
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA292883207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology