Provider Demographics
NPI:1790289379
Name:TROLL, NATHANAEL CLAYTON (DO)
Entity Type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:CLAYTON
Last Name:TROLL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:809 82ND PARKWAY
Mailing Address - Street 2:GME OFFICE
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29792
Mailing Address - Country:US
Mailing Address - Phone:843-692-1752
Mailing Address - Fax:843-692-1904
Practice Address - Street 1:809 82ND PARKWAY
Practice Address - Street 2:GME OFFICE
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29792
Practice Address - Country:US
Practice Address - Phone:843-692-1752
Practice Address - Fax:843-692-1904
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA05836207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine