Healthcare Provider Details

I. General information

NPI: 1568403038
Provider Name (Legal Business Name): BENJAMIN H NELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 MIDDLEBURY ST
GOSHEN IN
46528-2956
US

IV. Provider business mailing address

213 MIDDLEBURY ST
GOSHEN IN
46528-2956
US

V. Phone/Fax

Practice location:
  • Phone: 574-534-3300
  • Fax: 574-534-5412
Mailing address:
  • Phone: 574-534-3300
  • Fax: 574-534-5412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01035358A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: