{
"Npi": {
"NPI": "1891923199",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "AWEH",
"FirstName": "NELSON",
"MiddleName": "KISOB",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "AWEH",
"OtherFirstName": "NELSON",
"OtherMiddleName": "KISOB",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "MD",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "269 CARLISLE RD APT A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BEDFORD",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "01730-1536",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "617-642-0441",
"MailingAddressFaxNumber": "617-642-0441",
"FirstLinePracticeLocationAddress": "255 GARDEN ST",
"SecondLinePracticeLocationAddress": "APT # 7",
"PracticeLocationAddressCityName": "CAMBRIDGE",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "02138-1256",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "617-642-0441",
"PracticeLocationAddressFaxNumber": "617-642-0441",
"EnumerationDate": "06/24/2009",
"LastUpdateDate": "07/25/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "19629",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "240603",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208M00000X",
"TaxonomyName": "Hospitalist Physician",
"LicenseNumber": "253793",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}