Healthcare Provider Details

I. General information

NPI: 1861406753
Provider Name (Legal Business Name): NATHAN ERIC CARNELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 BANK CT SUITE 240
FREDERICK MD
21703-8483
US

IV. Provider business mailing address

7211 BANK CT SUITE 240
FREDERICK MD
21703-8483
US

V. Phone/Fax

Practice location:
  • Phone: 240-215-1454
  • Fax: 240-215-1453
Mailing address:
  • Phone: 240-215-1454
  • Fax: 240-215-1453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD0035695
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: