1992910699 NPI number — ANDERS P. NELSON, MD, PC

Table of content: (NPI 1992910699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992910699 NPI number — ANDERS P. NELSON, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDERS P. NELSON, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992910699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 399
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINCHILLA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18410-0399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-586-8879
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 LAYTON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKS SUMMIT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-586-8879
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
ANDERS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
570-586-8879

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD043822E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0011992910001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".