Healthcare Provider Details

I. General information

NPI: 1174663066
Provider Name (Legal Business Name): DAVID NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2329
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-1237
  • Fax:
Mailing address:
  • Phone: 702-383-3736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number338805
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number63616
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number042.0014336
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: