1891923199 NPI number — DR. NELSON KISOB AWEH MD

Table of content: DR. NELSON KISOB AWEH MD (NPI 1891923199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891923199 NPI number — DR. NELSON KISOB AWEH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AWEH
Provider First Name:
NELSON
Provider Middle Name:
KISOB
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AWEH
Provider Other First Name:
NELSON
Provider Other Middle Name:
KISOB
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1891923199
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
269 CARLISLE RD APT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01730-1536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-642-0441
Provider Business Mailing Address Fax Number:
617-642-0441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 GARDEN ST
Provider Second Line Business Practice Location Address:
APT # 7
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02138-1256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-642-0441
Provider Business Practice Location Address Fax Number:
617-642-0441
Provider Enumeration Date:
06/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  19629 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 240603 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 253793 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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