Provider Demographics
NPI:1205923299
Name:NATHANSON, MARK (DPM)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:NATHANSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6638 W ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-1616
Mailing Address - Country:US
Mailing Address - Phone:561-499-5050
Mailing Address - Fax:
Practice Address - Street 1:6638 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1616
Practice Address - Country:US
Practice Address - Phone:561-499-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOD 1087213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55439Medicare UPIN
FL1110290001Medicare NSC
FL87503Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER