Healthcare Provider Details

I. General information

NPI: 1306966320
Provider Name (Legal Business Name): MARC DAVID NATTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST YAWKEY 6C
BOSTON MA
02114
US

IV. Provider business mailing address

300 LONGWOOD AVE MAIL STOP: BCH3187
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-2730
  • Fax: 617-724-0581
Mailing address:
  • Phone: 857-218-3531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number223301
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: