Healthcare Provider Details

I. General information

NPI: 1902048499
Provider Name (Legal Business Name): NATHANAEL DAVID MCLEOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NATHAN DAVID MCLEOD M.D.

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HOSPITAL LN STE 110
DANVILLE IN
46122-2600
US

IV. Provider business mailing address

112 HOSPITAL LN STE 110
DANVILLE IN
46122-2600
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-3333
  • Fax: 317-386-5504
Mailing address:
  • Phone: 740-236-9047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01069969A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE7925
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01069969A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE7925
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01069969A
License Number StateIN
# 6
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number35.137089
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: