Provider Demographics
NPI:1992796437
Name:NATHAN, NIRMALA SENTHIL (MD)
Entity type:Individual
Prefix:
First Name:NIRMALA
Middle Name:SENTHIL
Last Name:NATHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER BOULEVARD
Mailing Address - Street 2:STE 341 CROZER REGIONAL CANCER CENTER
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3902
Mailing Address - Country:US
Mailing Address - Phone:610-619-7420
Mailing Address - Fax:610-876-6923
Practice Address - Street 1:1 MEDICAL CENTER BOULEVARD
Practice Address - Street 2:STE 341 CROZER REGIONAL CANCER CENTER
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-619-7420
Practice Address - Fax:610-876-6923
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063938L207RH0003X
NJ25MA07622100207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
04419800OtherECFMG
PA1008495540001Medicaid
H79982Medicare UPIN
PA068028G48Medicare PIN
NJ073231RVOMedicare PIN
04419800OtherECFMG