Individual
NATHAN KENNETH COLEBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
20 N MONTFORD AVE, BALTIMORE, MD 21224-1050
(814) 215-9047
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
(410) 933-2704
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C08156
MD
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1185755
NCCPA
—
01
—
C08156
STATE LICENSE
MD
Enumeration date
06/29/2021
Last updated
01/04/2024
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