MEDICARE: DR. MATTHEW HERBERT 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	318932	NY

General Provider Information

NPI Number	:	1932662111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW HERBERT NELSON MD

Provider Business Mailing Address
First Line	:	150 HIGHLAND AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-3099
Country	:	US
Telephone Number	:	585-760-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 HIGHLAND AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-3099
Country	:	US
Telephone Number	:	585-760-1300
Fax Number	:

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

Provider Enumeration Date	:	04/13/2019
Last Update Date	:	04/28/2023

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