Healthcare Provider Details

I. General information

NPI: 1770425605
Provider Name (Legal Business Name): NATHANIEL LOREN HAUSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIRCLE, PORTSMOUTH
PORTSMOUTH VA
23708
US

IV. Provider business mailing address

620 JOHN PAUL JONES CIRCLE, PORTSMOUTH
PORTSMOUTH VA
23708
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-2518
  • Fax:
Mailing address:
  • Phone: 757-953-2518
  • Fax: 757-953-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0116042573
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: