MEDICARE: NATHANIEL MCQUAY JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0102X	Surgical Critical Care Physician	D59114	MD
2	2086S0102X	Surgical Critical Care Physician	MD422208	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215962717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL MCQUAY JR. MD

Provider Business Mailing Address
First Line	:	11100 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1716
Country	:	US
Telephone Number	:	216-844-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	20800 HARVARD RD
Second Line	:	2ND FLOOR
City	:	HIGHLAND HILLS
State	:	OH
Zip	:	44122-7251
Country	:	US
Telephone Number	:	216-358-2156
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	01/14/2021

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