Healthcare Provider Details

I. General information

NPI: 1821513029
Provider Name (Legal Business Name): NATHAN L CRAIN PA-C, MPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DARTMOUTH HITCHCOCK - CARDIOLOGY
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DARTMOUTH HITCHCOCK - CARDIOLOGY
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-3539
  • Fax:
Mailing address:
  • Phone: 603-650-3539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1286
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: