Healthcare Provider Details

I. General information

NPI: 1760620082
Provider Name (Legal Business Name): NATHAN COLEMAN NUSSBAUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 TRYON RD
DURHAM NC
27705-5513
US

IV. Provider business mailing address

2501 TRYON RD
DURHAM NC
27705-5513
US

V. Phone/Fax

Practice location:
  • Phone: 773-680-3713
  • Fax:
Mailing address:
  • Phone: 773-680-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number283274
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2014-00628
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: