Healthcare Provider Details

I. General information

NPI: 1962458786
Provider Name (Legal Business Name): MATTHEW M NELSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 ATLEE RD
MECHANICSVILLE VA
23116-1844
US

IV. Provider business mailing address

5855 BREMO RD SUITE 100
RICHMOND VA
23226-1926
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-6258
  • Fax: 804-282-9921
Mailing address:
  • Phone: 804-288-6258
  • Fax: 804-282-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0102201598
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: