Provider Demographics
NPI:1568442077
Name:NELSON, DOUGLAS MARTIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MARTIN
Last Name:NELSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4235
Mailing Address - Country:US
Mailing Address - Phone:814-835-3338
Mailing Address - Fax:814-835-3668
Practice Address - Street 1:1326 PENINSULA DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4235
Practice Address - Country:US
Practice Address - Phone:814-835-3338
Practice Address - Fax:814-835-3668
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001726L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000863022Medicaid
T28345Medicare UPIN
PA000863022Medicaid