Provider Demographics
NPI:1679610786
Name:BREWER, NATHAN HALL (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:HALL
Last Name:BREWER
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 1:50 SEWALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2691
Mailing Address - Country:US
Mailing Address - Phone:207-775-3526
Mailing Address - Fax:207-775-5658
Practice Address - Street 1:50 SEWALL ST STE 302
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2691
Practice Address - Country:US
Practice Address - Phone:072-775-3526
Practice Address - Fax:207-277-5568
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD21459207N00000X, 207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty