Provider Demographics
NPI:1053411447
Name:NATHANIEL TRAVIS MARVEL, JR.
Entity type:Organization
Organization Name:NATHANIEL TRAVIS MARVEL, JR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:MARVEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:513-535-1064
Mailing Address - Street 1:PO BOX 643680
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-3680
Mailing Address - Country:US
Mailing Address - Phone:513-891-2813
Mailing Address - Fax:513-793-1032
Practice Address - Street 1:143 LAKEVIEW CT.
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140
Practice Address - Country:US
Practice Address - Phone:513-535-1064
Practice Address - Fax:513-774-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0513422084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDF0430OtherRR MEDICARE
OHDF0430OtherRR MEDICARE