Provider Demographics
NPI:1457301145
Name:NELSON, ANDERS P (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDERS
Middle Name:P
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:CHINCHILLA
Mailing Address - State:PA
Mailing Address - Zip Code:18410-0399
Mailing Address - Country:US
Mailing Address - Phone:570-586-8879
Mailing Address - Fax:570-586-3953
Practice Address - Street 1:110 LAYTON RD
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9031
Practice Address - Country:US
Practice Address - Phone:570-586-8879
Practice Address - Fax:570-586-3953
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD043822E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE40988Medicare UPIN