MEDICARE: DR. JOSHUA COOK NELSON D.O

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	34007237N	OH
2	2084P0800X	Psychiatry Physician	34007237	OH

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DA5551	OTHER	OH	MEDICARE RAILROAD GROUP
5	00063092	OTHER	OH	MEDICARE RAILROAD
7	9339121	OTHER	OH	MEDICARE GROUP NUMBER

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000314457	OTHER	OH	ANTHEM
2	0501308	OTHER	OH	UNITED HEALTHCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	33409	OTHER	OH	NATIONWIDE

NPI Number	:	1609870344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA COOK NELSON D.O

Provider Business Mailing Address
First Line	:	3828 RACCOON VALLEY RD
Second Line	:
City	:	ALEXANDRIA
State	:	OH
Zip	:	43001-9744
Country	:	US
Telephone Number	:	740-587-1895
Fax Number	:

Provider Business Practice Location Address
First Line	:	1916 TAMARACK RD
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-2303
Country	:	US
Telephone Number	:	740-522-6110
Fax Number	:	740-522-0126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	08/11/2017

1916 TAMARACK RD
NEWARK, OH
43055-2303

Practice Phone: 740-522-6110
Practice Fax: 740-522-0126

1930 TAMARACK RD
NEWARK, OH
43055-2303