Healthcare Provider Details

I. General information

NPI: 1871549311
Provider Name (Legal Business Name): NATHAN CONGDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

PO BOX 64481
BALTIMORE MD
21264-4481
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-2360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD53447
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: