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General NPI Number Information
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NPI Number | 1053411447
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Entity Type | Organization
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Legal Business Name | NATHANIEL TRAVIS MARVEL, JR.
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 143 LAKEVIEW CT.
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City | LOVELAND
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State | OH
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Zip | 45140
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Country | US
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Telephone | 513-535-1064
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Fax | 513-774-8612
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Provider Business Mailing Address
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Address Line | PO BOX 643680
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City | CINCINNATI
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State | OH
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Zip | 45264-3680
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Country | US
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Telephone | 513-891-2813
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Fax | 513-793-1032
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Authorized Official
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Title or Position | OWNER
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Name | DR. NATHANIEL TRAVIS MARVEL JR.
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Credential | MD
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Telephone | 513-535-1064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 35-051342
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License Number State | OH
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