Provider Demographics
NPI:1912041963
Name:GUNN, NATHANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:
Last Name:GUNN
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 1:201 JONES RD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1600
Mailing Address - Country:US
Mailing Address - Phone:781-693-3786
Mailing Address - Fax:781-207-0097
Practice Address - Street 1:201 JONES RD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1600
Practice Address - Country:US
Practice Address - Phone:781-693-3786
Practice Address - Fax:781-207-0097
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine