Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | D59114 | MD |
Y | 2086S0102X | Surgical Critical Care | MD422208 | PA |
NPI | 1215962717 |
---|---|
Provider Name | Nathaniel Mcquay JR. |
First Address | Cleveland, OH 44106-1716 |
Second Address | Highland Hills, OH 44122-7251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 14/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001971267 | (05) | PA |
038034200 | (05) | MD |
H93921 | (02) | PA |