=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558568857
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHAN ALLEN DECKARD M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2007
-----------------------------------------------------
Last Update Date | 12/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 MILFORD STREET STE 101
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21804-6966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-742-1567
-----------------------------------------------------
Fax | 410-742-1906
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 MILFORD STREET STE 101
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21804-6966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-742-1567
-----------------------------------------------------
Fax | 410-742-1906
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | D86276
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 4301090482
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------