Provider Demographics
NPI:1386620789
Name:DRUM, NATHAN H (OD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:H
Last Name:DRUM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576-2110
Mailing Address - Country:US
Mailing Address - Phone:603-237-4500
Mailing Address - Fax:603-237-9900
Practice Address - Street 1:109 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576-2110
Practice Address - Country:US
Practice Address - Phone:603-237-4500
Practice Address - Fax:603-237-9900
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0300000272152W00000X
NH552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH410036263OtherRR MEDICARE
NH30010684Medicaid
NH0903642Y0NH01OtherBC BS
NH0903642Y0NH01OtherBC BS
T89046Medicare UPIN