Provider Demographics
NPI:1386602290
Name:LEU, NATHAN JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JAMES
Last Name:LEU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1577 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2169
Mailing Address - Country:US
Mailing Address - Phone:207-662-5522
Mailing Address - Fax:207-774-1814
Practice Address - Street 1:1577 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-662-5522
Practice Address - Fax:207-774-1814
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD22180207Q00000X, 207SG0201X
OH35073229207Q00000X
MDD80007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine