Provider Demographics
NPI:1659958767
Name:GORRELL, NATHAN ROY (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ROY
Last Name:GORRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4460 RED BANK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2173
Mailing Address - Country:US
Mailing Address - Phone:513-564-3870
Mailing Address - Fax:513-564-3871
Practice Address - Street 1:4460 RED BANK RD STE 100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2173
Practice Address - Country:US
Practice Address - Phone:513-564-3870
Practice Address - Fax:513-564-3871
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.150985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH390200000XMedicaid