Provider Demographics
NPI:1720048572
Name:NATHAN, JOSHUA BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:BENJAMIN
Last Name:NATHAN
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 1:1 E ERIE ST STE 525
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2980
Mailing Address - Country:US
Mailing Address - Phone:312-820-9127
Mailing Address - Fax:415-397-3629
Practice Address - Street 1:581 ELM PL STE 110
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3122
Practice Address - Country:US
Practice Address - Phone:888-428-7890
Practice Address - Fax:630-428-7891
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1715212084P0800X
COCDR.00010232084P0800X
IL036.1242762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7058272Medicaid
RI413480OtherBLUE CHIP OF RHODE ISLAND
RI9423396OtherPRIVATE HEALTH CARE SYSTEMS
RI7058272Medicaid
RI5754393OtherFIRST HEALTH NETWORK/COVENTRY HEALTHCARE
RI31460-4OtherBLUE CROSS/BLUE SHIELD OF RHODE ISLAND
RI7058272Medicaid