MEDICARE: NATHANIEL D. HARE 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	207K00000X	Allergy & Immunology Physician	MD448662	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	285759TYA	OTHER	PA	MEDICARE PTAN

General Provider Information

NPI Number	:	1598974560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL D. HARE M.D.

Provider Business Mailing Address
First Line	:	1201 GRAMPIAN BLVD
Second Line	:
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701-1900
Country	:	US
Telephone Number	:	570-326-8723
Fax Number	:	570-326-8922

Provider Business Practice Location Address
First Line	:	451 RIVER AVE
Second Line	:
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701-3722
Country	:	US
Telephone Number	:	570-320-7070
Fax Number	:	570-320-7071

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	06/02/2020

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