Provider Demographics
NPI:1922156272
Name:NATHAN, ANDREW J
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:NATHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2819
Mailing Address - Country:US
Mailing Address - Phone:603-772-3462
Mailing Address - Fax:603-778-3930
Practice Address - Street 1:2 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2819
Practice Address - Country:US
Practice Address - Phone:603-772-3462
Practice Address - Fax:603-778-3930
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH973103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical