MEDICARE: NATHANIEL S DOE M.D.

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	207RN0300X	Nephrology Physician	35063443D	OH
2	207RN0300X	Nephrology Physician	MD056504L	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	:	1275504094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL S DOE M.D.

Provider Business Mailing Address
First Line	:	1340 BELMONT AVE
Second Line	:	SUITE 2300
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44504-1125
Country	:	US
Telephone Number	:	330-746-1488
Fax Number	:	330-746-5611

Provider Business Practice Location Address
First Line	:	1340 BELMONT AVE
Second Line	:	SUITE 2300
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44504-1125
Country	:	US
Telephone Number	:	330-746-1488
Fax Number	:	330-746-5611

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	04/03/2014

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Directions to “ NATHANIEL S DOE M.D.” Practice Location

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