Provider Demographics
NPI:1902048499
Name:MCLEOD, NATHANAEL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:DAVID
Last Name:MCLEOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:DAVID
Other - Last Name:MCLEOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:112 HOSPITAL LN
Mailing Address - Street 2:STE 110
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-2600
Mailing Address - Country:US
Mailing Address - Phone:740-236-9047
Mailing Address - Fax:
Practice Address - Street 1:112 HOSPITAL LN STE 110
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-2600
Practice Address - Country:US
Practice Address - Phone:317-745-3333
Practice Address - Fax:317-386-5504
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069969A207Q00000X, 207R00000X, 207RI0200X
ARE7925207R00000X, 207Q00000X
OH35.137089207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine