1922080498 NPI number — DR. DAVID ALAN NIELSEN D.O.

Table of content: DR. DAVID ALAN NIELSEN D.O. (NPI 1922080498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922080498 NPI number — DR. DAVID ALAN NIELSEN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIELSEN
Provider First Name:
DAVID
Provider Middle Name:
ALAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1922080498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
183 SPOTNAP RD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22911-8812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-244-8412
Provider Business Mailing Address Fax Number:
434-244-8415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
183 SPOTNAP RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22911-8812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-244-8412
Provider Business Practice Location Address Fax Number:
434-244-8415
Provider Enumeration Date:
11/18/2005

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: 207X00000X , with the licence number:  0102201260 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020577234 . This is a "CHAMPUS/TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 020577234 . This is a "VA HEALTH NETWORK INS CO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 020577234 . This is a "FIRST HEALTH INSURANCE CO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 6270745 . This is a "CIGNA INSURANCE COMPANY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 276483 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 200044354 . This is a "PALMETTO GBA RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 020577234 . This is a "PHCS INSURANCE CO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 184497 . This is a "SOUTHERN HEALTH INS CO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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