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NPI Code Detail

MEDICARE: MARILYN MK NELSON MD

MEDICARE: MARILYN MK 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
1207Q00000XFamily Medicine PhysicianD0065518MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497776173
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN MK NELSON MD
Provider Business Mailing Address
First Line : 33 LEWIS RD
Second Line : 2ND FL
City : BINGHAMTON
State : NY
Zip : 13905
Country : US
Telephone Number : 607-729-8156
Fax Number : 607-729-3982
Provider Business Practice Location Address
First Line : 1302 E MAIN ST
Second Line :
City : ENDICOTT
State : NY
Zip : 13760-5430
Country : US
Telephone Number : 607-754-2323
Fax Number : 607-754-1846
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 02/18/2019

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Directions to “ MARILYN MK NELSON MD” Practice Location

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