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General NPI Number Information
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NPI Number | 1306307335
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Entity Type | Individual
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Provider Name | KYLE FITZGERALD NELSON MD
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Gender | Male
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Dates
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Enumeration Date | 03/31/2019
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 100 E LANCASTER AVE LANKENAU HEART PAVILION, MEZZANINE LEVEL
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City | WYNNEWOOD
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State | PA
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Zip | 19096-3435
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Country | US
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Telephone | 484-476-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 3803 W CHESTER PIKE STE 160
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073-2336
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Country | US
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Telephone | 484-337-1632
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD487714
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License Number State | PA
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