MEDICARE: DR. DAVID E. NATHANSON PH.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	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PY 3839	FL

General Provider Information

NPI Number	:	1316247208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID E. NATHANSON PH.D

Provider Business Mailing Address
First Line	:	5012 WESLEY DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1375
Country	:	US
Telephone Number	:	813-971-6026
Fax Number	:	813-971-6026

Provider Business Practice Location Address
First Line	:	5012 WESLEY DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1375
Country	:	US
Telephone Number	:	813-971-6026
Fax Number	:	813-971-6026

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

Provider Enumeration Date	:	10/26/2010
Last Update Date	:	10/26/2010

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