Healthcare Provider Details

I. General information

NPI: 1134112808
Provider Name (Legal Business Name): SCOTT ANDREW NELTNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 CHANCELLOR DR
CRESTVIEW HILLS KY
41017-5479
US

IV. Provider business mailing address

PO BOX 636256 CENTRAL CREDENTIALING
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-1878
  • Fax: 859-341-0560
Mailing address:
  • Phone: 513-585-5505
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number31407
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number31407
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: