Healthcare Provider Details

I. General information

NPI: 1487616116
Provider Name (Legal Business Name): TOBY NATHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 NORTH RD SUITE 202
BEDFORD MA
01730-1037
US

IV. Provider business mailing address

41 NORTH RD SUITE 202
BEDFORD MA
01730-1037
US

V. Phone/Fax

Practice location:
  • Phone: 781-275-2080
  • Fax: 781-275-5543
Mailing address:
  • Phone: 781-275-2080
  • Fax: 781-275-5543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number37342
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: