Basic Information
| Provider Information | |||||||||
| NPI: | 1285928358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARGUS | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 963 SARGENT AVE | ||||||||
| Address2: | |||||||||
| City: | BRYN MAWR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190103007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105253643 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 EAST LANCASTER AVENUE | ||||||||
| Address2: | LANKENAU HOSPITAL, INTERNAL MEDICINE DEPT. | ||||||||
| City: | WYNNEWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4844763988 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2011 | ||||||||
| LastUpdateDate: | 06/06/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT199612 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | HS000121L | 01 | PA | LANKENAU HOSPITAL TRAINING LICENSE NUMBER | OTHER | MT199612 | 01 | PA | GRADUATE MEDICAL TRAINEE LICENSE NUMBER | OTHER |