Provider Demographics
NPI:1467465039
Name:ROSS NATHAN MD, INC.
Entity type:Organization
Organization Name:ROSS NATHAN MD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-424-9000
Mailing Address - Street 1:3918 LONG BEACH BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2666
Mailing Address - Country:US
Mailing Address - Phone:562-424-9000
Mailing Address - Fax:562-424-9067
Practice Address - Street 1:3918 LONG BEACH BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2666
Practice Address - Country:US
Practice Address - Phone:562-424-9000
Practice Address - Fax:562-424-9067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63130207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G631300Medicaid
CAE36252Medicare UPIN
CA00G631300Medicaid
CA1079860001Medicare NSC