Healthcare Provider Details

I. General information

NPI: 1558568857
Provider Name (Legal Business Name): NATHAN ALLEN DECKARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MILFORD STREET STE 101
SALISBURY MD
21804-6966
US

IV. Provider business mailing address

106 MILFORD STREET STE 101
SALISBURY MD
21804-6966
US

V. Phone/Fax

Practice location:
  • Phone: 410-742-1567
  • Fax: 410-742-1906
Mailing address:
  • Phone: 410-742-1567
  • Fax: 410-742-1906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD86276
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301090482
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: