Provider Demographics
NPI:1790083657
Name:MILETTA, NATHANIAL R (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIAL
Middle Name:R
Last Name:MILETTA
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 1:826 WASHINGTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4071
Mailing Address - Country:US
Mailing Address - Phone:153-395-4918
Mailing Address - Fax:315-755-3670
Practice Address - Street 1:826 WASHINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4071
Practice Address - Country:US
Practice Address - Phone:315-395-4918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26961207N00000X
NY298285207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology