Healthcare Provider Details

I. General information

NPI: 1932477981
Provider Name (Legal Business Name): NATHANAEL EDWARD HATHAWAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NATE HATHAWAY M.D.

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberD0106988
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101250715
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number0101250715
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0106988
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: