Provider Demographics
NPI:1023067543
Name:NATH, AMARESH RAJESHWAR (MD)
Entity type:Individual
Prefix:
First Name:AMARESH
Middle Name:RAJESHWAR
Last Name:NATH
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 1:3055 HAMILTON MASON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-5307
Mailing Address - Country:US
Mailing Address - Phone:513-793-2654
Mailing Address - Fax:513-454-3053
Practice Address - Street 1:3055 HAMILTON MASON RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011-5307
Practice Address - Country:US
Practice Address - Phone:513-793-2654
Practice Address - Fax:513-454-3053
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-072307207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64092802Medicaid
IN200207290Medicaid
OH2123964Medicaid
OH2123964Medicaid
G73261Medicare UPIN
OHNA4143591Medicare PIN