Provider Demographics
NPI:1053308361
Name:NELSON, ANDREW J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1320 WEST MAIN ST
Mailing Address - Street 2:NOSS
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3119
Mailing Address - Country:US
Mailing Address - Phone:203-755-7115
Mailing Address - Fax:203-755-7067
Practice Address - Street 1:500 CHASE PARKWAY
Practice Address - Street 2:NOSS
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3119
Practice Address - Country:US
Practice Address - Phone:203-755-7115
Practice Address - Fax:203-755-7067
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2016-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT36972207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00071OtherMEDICARE GROUP NUMBER
CTD400282942Medicare PIN
CTC00071OtherMEDICARE GROUP NUMBER