1265458004 NPI number — WATERMARK LOGAN PARTNERS, L.P.

Table of content: DR. ALFRED DENNYSON NELSON MD (NPI 1518329770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265458004 NPI number — WATERMARK LOGAN PARTNERS, L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WATERMARK LOGAN PARTNERS, L.P.
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:
6
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:
1265458004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2020 W RUDASILL RD
Provider Second Line Business Mailing Address:
SECOND FLOOR
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85704-7800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-297-9800
Provider Business Mailing Address Fax Number:
520-797-7757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 FRANKLIN TOWN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19103-1238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-563-1800
Provider Business Practice Location Address Fax Number:
215-563-7976
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRESHWATER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
520-297-9800

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  127502 , 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: 0017525740001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com