Provider Demographics
NPI:1487143442
Name:NATHAN, ADITYA
Entity type:Individual
Prefix:MR
First Name:ADITYA
Middle Name:
Last Name:NATHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY PKWY APT 105
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-8224
Mailing Address - Country:US
Mailing Address - Phone:503-962-9023
Mailing Address - Fax:
Practice Address - Street 1:1300 E MULLAN AVE STE 1600
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6054
Practice Address - Country:US
Practice Address - Phone:208-625-4965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-05
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-1976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine