Provider Demographics
NPI:1033152541
Name:NELSON, SIDNEY III (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:
Last Name:NELSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 SABRE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7380
Mailing Address - Country:US
Mailing Address - Phone:757-222-0300
Mailing Address - Fax:
Practice Address - Street 1:1840 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-1305
Practice Address - Country:US
Practice Address - Phone:757-222-0300
Practice Address - Fax:757-956-9806
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD63298208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409172800Medicaid
MDCA8374OtherR/R MEDICARE GROUP #
MDP00309490OtherR/R MEDICARE PROVIDER #
MDI48556Medicare UPIN
MDS589N210Medicare PIN