Provider Demographics
NPI:1568651180
Name:NELSON, ELIZABETH T (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:T
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 1:2401 S KANAWHA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6967
Mailing Address - Country:US
Mailing Address - Phone:304-317-6095
Mailing Address - Fax:304-317-6094
Practice Address - Street 1:2401 S KANAWHA ST STE 100
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6967
Practice Address - Country:US
Practice Address - Phone:304-317-6095
Practice Address - Fax:304-317-6094
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL30356208M00000X
WV23802207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC303567Medicaid
SC576008010013OtherBCBS
SC000000225644OtherUNISON
SC2066855OtherFIRST CHOICE
SCAA23757399Medicare PIN
SC576008010013OtherBCBS