Provider Demographics
NPI:1245882182
Name:NATHU, ADILA (MD,PA)
Entity type:Individual
Prefix:DR
First Name:ADILA
Middle Name:
Last Name:NATHU
Suffix:
Gender:F
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12188-2455
Mailing Address - Country:US
Mailing Address - Phone:518-237-0641
Mailing Address - Fax:
Practice Address - Street 1:46 3RD ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:NY
Practice Address - Zip Code:12188-2455
Practice Address - Country:US
Practice Address - Phone:518-237-0641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000056207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology