Healthcare Provider Details

I. General information

NPI: 1477512986
Provider Name (Legal Business Name): NATHAN ERTESCHIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3673 GLENBARRY CIR
FAYETTEVILLE NC
28314-2605
US

IV. Provider business mailing address

3673 GLENBARRY CIR
FAYETTEVILLE NC
28314-2605
US

V. Phone/Fax

Practice location:
  • Phone: 910-864-9172
  • Fax:
Mailing address:
  • Phone: 910-864-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: