Healthcare Provider Details

I. General information

NPI: 1205369857
Provider Name (Legal Business Name): NATHANIEL ALEXANDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 SMITH RD BLDG 23
NEWPORT RI
02841-1006
US

IV. Provider business mailing address

43 SMITH RD BLDG 23
NEWPORT RI
02841-1006
US

V. Phone/Fax

Practice location:
  • Phone: 401-841-3771
  • Fax:
Mailing address:
  • Phone: 401-841-4115
  • Fax: 401-841-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberMD26724
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD26724
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: