MEDICARE: MARK WARREN NELSON D.O.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	58.002167	OH
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	34.009868	OH

General Provider Information

NPI Number	:	1346496163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK WARREN NELSON D.O.

Provider Business Mailing Address
First Line	:	7590 AUBURN RD
Second Line	:
City	:	CONCORD TWP
State	:	OH
Zip	:	44077-9176
Country	:	US
Telephone Number	:	440-354-4208
Fax Number	:	440-354-1151

Provider Business Practice Location Address
First Line	:	7590 AUBURN RD
Second Line	:
City	:	CONCORD TWP
State	:	OH
Zip	:	44077-9176
Country	:	US
Telephone Number	:	440-354-4208
Fax Number	:	440-354-1151

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

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	05/17/2011

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