Individual
DR. MICHAEL THOMAS NATHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 OCEAN AVE, RHC REVERE HEALTHCARE CENTER, REVERE, MA 02151-3675
(781) 485-6300
(781) 485-6392
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(781) 485-6300
(781) 485-6392
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
72450
MA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
72450
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
072450
TUFTS HEALTH PLAN
MA
05
—
3078531
—
MA
01
—
J11198
BCBS MA
MA
Enumeration date
11/14/2005
Last updated
04/16/2014
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