Healthcare Provider Details

I. General information

NPI: 1245496520
Provider Name (Legal Business Name): BENJAMIN NELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1971
US

IV. Provider business mailing address

PO BOX 11049
NORFOLK VA
23517-0049
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-8177
  • Fax:
Mailing address:
  • Phone: 757-668-8177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101246168
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: