Provider Demographics
NPI:1043205891
Name:NELSON, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:NELSON
Suffix:
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:CAPITAL CARDIOLOGY ASSOCIATES, PC
Mailing Address - Street 2:7 SOUTHWOODS BLVD
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-2526
Mailing Address - Country:US
Mailing Address - Phone:518-292-6000
Mailing Address - Fax:518-641-6766
Practice Address - Street 1:7 SOUTHWOODS BLVD
Practice Address - Street 2:CAPITAL CARDIOLOGY ASSOCIATES PC
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12211-2526
Practice Address - Country:US
Practice Address - Phone:518-292-6000
Practice Address - Fax:518-641-6766
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159693207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01547451Medicaid
VT1007533Medicaid
MA2011841Medicaid
NY01547451Medicaid
MA2011841Medicaid