Provider Demographics
NPI:1366882409
Name:GWILLIAM, NATHAN RHYS (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:RHYS
Last Name:GWILLIAM
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 1:1 MACDONOUGH PL
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3607
Mailing Address - Country:US
Mailing Address - Phone:860-358-8760
Mailing Address - Fax:860-358-8280
Practice Address - Street 1:1 MACDONOUGH PL
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3607
Practice Address - Country:US
Practice Address - Phone:860-358-8801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-061750208600000X
CT67747390200000X
CT717822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program