Provider Demographics
NPI:1487616116
Name:NATHAN, TOBY (MD)
Entity type:Individual
Prefix:
First Name:TOBY
Middle Name:
Last Name:NATHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 NORTH RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1037
Mailing Address - Country:US
Mailing Address - Phone:781-275-2080
Mailing Address - Fax:781-275-5543
Practice Address - Street 1:41 NORTH RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1037
Practice Address - Country:US
Practice Address - Phone:781-275-2080
Practice Address - Fax:781-275-5543
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA373422080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA600421OtherTUFTS HEALTH PLAN
MA2054728Medicaid
MAB52009OtherBLUE CROSS BLUE SHIELD
MA2054728Medicaid