Individual
NATHANIEL FASTENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6111 E ARBOR AVE, MESA, AZ 85206-6059
(480) 981-1326
(480) 981-1445
Mailing address
PO BOX 6423, CHANDLER, AZ 85246-6423
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
11622
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
236217
AHCCCS
AZ
01
—
P00329821
RAILROAD MEDICARE
AZ
Enumeration date
09/12/2005
Last updated
06/04/2014
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