Provider Demographics
NPI:1093711954
Name:NELSON, BETH E (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:E
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 1:1000 ASYLUM AVE
Mailing Address - Street 2:STE 2110
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1719
Mailing Address - Country:US
Mailing Address - Phone:860-714-7945
Mailing Address - Fax:860-714-8880
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:STE 2110
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1719
Practice Address - Country:US
Practice Address - Phone:860-714-7945
Practice Address - Fax:860-714-8880
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029762207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00129762Medicaid
CTD86986Medicare UPIN
CT00129762Medicaid