Provider Demographics
NPI:1043591597
Name:NELSON, MARCIA M (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4262 OLD WILLIAM PENN HWY STE 109
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1954
Mailing Address - Country:US
Mailing Address - Phone:724-325-6010
Mailing Address - Fax:724-327-4690
Practice Address - Street 1:4262 OLD WILLIAM PENN HWY STE 109
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1954
Practice Address - Country:US
Practice Address - Phone:724-325-6010
Practice Address - Fax:724-327-4690
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442925207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102632018Medicaid
PA228267Medicare PIN