Provider Demographics
NPI:1316916489
Name:NATH, RONALD L (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:NATH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:91 MONTVALE AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3623
Mailing Address - Country:US
Mailing Address - Phone:781-279-1123
Mailing Address - Fax:781-438-3034
Practice Address - Street 1:91 MONTVALE AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3623
Practice Address - Country:US
Practice Address - Phone:781-279-1123
Practice Address - Fax:781-438-3034
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA37914208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6187447Medicaid
MAB53093OtherBCBS
MA6187447Medicaid
MAB53093OtherBCBS