Provider Demographics
NPI:1871591255
Name:NATHANSON, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:NATHANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 ROUTE 51
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3652
Mailing Address - Country:US
Mailing Address - Phone:412-469-1500
Mailing Address - Fax:412-469-1531
Practice Address - Street 1:1633 ROUTE 51
Practice Address - Street 2:SUITE 103
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3652
Practice Address - Country:US
Practice Address - Phone:412-469-1500
Practice Address - Fax:412-469-1531
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048888L207RC0000X
PAMD048888-I207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1392710Medicaid
E59233Medicare UPIN
PA1392710Medicaid