Provider Demographics
NPI:1912114547
Name:MEENA R NATHAN MD PA
Entity Type:Organization
Organization Name:MEENA R NATHAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEENA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-637-6300
Mailing Address - Street 1:840 S BEA AVE
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-3603
Mailing Address - Country:US
Mailing Address - Phone:352-637-6300
Mailing Address - Fax:352-637-6480
Practice Address - Street 1:840 S BEA AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-3603
Practice Address - Country:US
Practice Address - Phone:352-637-6300
Practice Address - Fax:352-637-6480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103934Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER