MEDICARE: DR. KYLE FITZGERALD NELSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MD487714	PA

General Provider Information

NPI Number	:	1306307335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE FITZGERALD NELSON MD

Provider Business Mailing Address
First Line	:	3803 W CHESTER PIKE STE 160
Second Line	:
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-2336
Country	:	US
Telephone Number	:	484-337-1632
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 E LANCASTER AVE
Second Line	:	LANKENAU HEART PAVILION, MEZZANINE LEVEL
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-3435
Country	:	US
Telephone Number	:	484-476-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2019
Last Update Date	:	08/07/2025

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