Provider Demographics
NPI:1336726108
Name:O'LEARY, NATHANIEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:DAVID
Last Name:O'LEARY
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 1:2020 59TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-4669
Mailing Address - Country:US
Mailing Address - Phone:941-798-6513
Mailing Address - Fax:
Practice Address - Street 1:95 LEONARD AVE STE 200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3368
Practice Address - Country:US
Practice Address - Phone:724-223-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PA484527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program