Healthcare Provider Details

I. General information

NPI: 1053307249
Provider Name (Legal Business Name): JOHN P NELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SHADY AVE D-108
PITTSBURGH PA
15206-4460
US

IV. Provider business mailing address

401 SHADY AVE D-108
PITTSBURGH PA
15206-4460
US

V. Phone/Fax

Practice location:
  • Phone: 412-661-9008
  • Fax: 412-661-1055
Mailing address:
  • Phone: 412-661-9008
  • Fax: 412-661-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD028096E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD028096E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: