Provider Demographics
NPI:1497804702
Name:NITENSON, NANCY CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:CAROL
Last Name:NITENSON
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 1:935 GREAT PLAIN AVE # 117
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-3031
Mailing Address - Country:US
Mailing Address - Phone:617-608-3724
Mailing Address - Fax:
Practice Address - Street 1:935 GREAT PLAIN AVE # 117
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-3031
Practice Address - Country:US
Practice Address - Phone:617-608-3724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA591612084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE76200Medicare UPIN
J10803Medicare ID - Type Unspecified