Provider Demographics
NPI:1861406753
Name:CARNELL, NATHAN ERIC (MD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:ERIC
Last Name:CARNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7211 BANK CT
Mailing Address - Street 2:SUITE 240
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8483
Mailing Address - Country:US
Mailing Address - Phone:240-215-1454
Mailing Address - Fax:240-215-1453
Practice Address - Street 1:7211 BANK CT
Practice Address - Street 2:SUITE 240
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8483
Practice Address - Country:US
Practice Address - Phone:240-215-1454
Practice Address - Fax:240-215-1453
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035695207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD530121100Medicaid
MDK935Medicare PIN
MD530121100Medicaid
MD460001939Medicare PIN
K9350090Medicare ID - Type Unspecified