Basic Information
| Provider Information | |||||||||
| NPI: | 1891748141 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NATHAN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 WINDLE CT | ||||||||
| Address2: | |||||||||
| City: | COATESVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193201351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103848613 | ||||||||
| FaxNumber: | 6103848613 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 W LANCASTER AVE | ||||||||
| Address2: | |||||||||
| City: | PAOLI | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193011763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845651000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 08/13/2010 | ||||||||
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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 | 207P00000X | MD042148E | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0012630600007 | 05 | PA | MEDICAID | BN1595505 | 01 | DEA | OTHER |