MEDICARE: NELSON CHARLIE MD PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	ME 85619	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750404844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NELSON CHARLIE MD PA

Provider Business Mailing Address
First Line	:	1800 SE 10TH AVE
Second Line	:	STE. 305
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2901
Country	:	US
Telephone Number	:	954-467-4100
Fax Number	:	954-467-4080

Provider Business Practice Location Address
First Line	:	1800 SE 10TH AVE
Second Line	:	STE. 305
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2901
Country	:	US
Telephone Number	:	954-467-4100
Fax Number	:	954-467-4080

Authorized Official
Title or Position	:	CEO OWNER
Name	:	DR. NELSON CHARLIE
Credential	:	M.D.
Telephone Number	:	954-467-4100

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	04/01/2008

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Directions to “NELSON CHARLIE MD PA ” Practice Location

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