Provider Demographics
NPI:1093777005
Name:NELSON, OWEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:OWEN
Middle Name:A
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:116 NORTHPORT AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6095
Mailing Address - Country:US
Mailing Address - Phone:207-930-6746
Mailing Address - Fax:207-930-6747
Practice Address - Street 1:116 NORTHPORT AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6095
Practice Address - Country:US
Practice Address - Phone:207-930-6746
Practice Address - Fax:207-930-6747
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD023339E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAA72557Medicare UPIN
PA1399322QB1Medicare ID - Type UnspecifiedMEDICARE