1952323461 NPI number — NELSON MEDICAL GROUP

Table of content: (NPI 1952323461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952323461 NPI number — NELSON MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NELSON MEDICAL GROUP
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:
1952323461
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:
255 S 17TH ST
Provider Second Line Business Mailing Address:
SUITE 2001
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19103-6231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-546-7049
Provider Business Mailing Address Fax Number:
215-546-8646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 S 17TH ST
Provider Second Line Business Practice Location Address:
SUITE 2001
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19103-6231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-546-7049
Provider Business Practice Location Address Fax Number:
215-546-8646
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
215-546-7049

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1912952789 . This is a "NPI#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MD050257L . This is a "MEDICAL LICENCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: OS006039L . This is a "LICENSE #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MD051318L . This is a "LICENSE #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MD050204L . This is a "LISCENCE NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MD050257L . This is a "MEDICAL LISCENCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MD013724E . This is a "MEDICAL LISCENCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MD004666E . This is a "MEDICAL LISCENCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MD033656L . This is a "LICENSE #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: C31657 . This is a "UPIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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