Provider Demographics
NPI:1407909237
Name:NELSON, VIRGINIA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:ANN
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 1:6700 KIRKVILLE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9373
Mailing Address - Country:US
Mailing Address - Phone:315-559-0375
Mailing Address - Fax:
Practice Address - Street 1:6700 KIRKVILLE RD STE 104
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9373
Practice Address - Country:US
Practice Address - Phone:315-559-0375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196221207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB6594Medicare ID - Type Unspecified