Provider Demographics
NPI:1972515591
Name:NATHANIEL, CYRIL (MD)
Entity Type:Individual
Prefix:DR
First Name:CYRIL
Middle Name:
Last Name:NATHANIEL
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 1:1015 FRANKLIN ST
Mailing Address - Street 2:WESSEL BUILDING LEVEL D
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4110
Mailing Address - Country:US
Mailing Address - Phone:814-534-5042
Mailing Address - Fax:
Practice Address - Street 1:1015 FRANKLIN ST
Practice Address - Street 2:WESSEL BUILDING LEVEL D
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4110
Practice Address - Country:US
Practice Address - Phone:814-534-5042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058575L207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01584316Medicaid
PA01584316Medicaid
PA01584316Medicaid