Healthcare Provider Details

I. General information

NPI: 1386684017
Provider Name (Legal Business Name): RICHARD S. NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 FOUNDRY ST SUITE 201
CONCORD NH
03301-5421
US

IV. Provider business mailing address

18 FOUNDRY ST SUITE 201
CONCORD NH
03301-5421
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-0071
  • Fax: 603-227-7535
Mailing address:
  • Phone: 603-228-0071
  • Fax: 603-227-7535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9194
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: