Provider Demographics
NPI:1336258193
Name:NATHANSON, IAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:T
Last Name:NATHANSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:NEMOURS CHILDREN&APOS S CLINIC
Mailing Address - Street 2:PO BOX 409992
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0001
Mailing Address - Country:US
Mailing Address - Phone:904-390-3610
Mailing Address - Fax:904-288-5890
Practice Address - Street 1:1717 S ORANGE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2944
Practice Address - Country:US
Practice Address - Phone:407-650-7000
Practice Address - Fax:407-650-7124
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME553432080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1528293Medicaid
FL061890000Medicaid
08676XMedicare PIN
LA1528293Medicaid