Healthcare Provider Details

I. General information

NPI: 1063400331
Provider Name (Legal Business Name): DAVID NELSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

PO BOX 418283
BOSTON MA
02241-8283
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-5437
  • Fax:
Mailing address:
  • Phone: 703-558-1544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18537
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: