Provider Demographics
NPI:1609870344
Name:NELSON, JOSHUA COOK (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:COOK
Last Name:NELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 RACCOON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:OH
Mailing Address - Zip Code:43001-9744
Mailing Address - Country:US
Mailing Address - Phone:740-587-1895
Mailing Address - Fax:
Practice Address - Street 1:1916 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2303
Practice Address - Country:US
Practice Address - Phone:740-522-6110
Practice Address - Fax:740-522-0126
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007237N174400000X
OH340072372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000314457OtherANTHEM
OH0501308OtherUNITED HEALTHCARE
OHDA5551OtherMEDICARE RAILROAD GROUP
OH2137557Medicaid
OH00063092OtherMEDICARE RAILROAD
OH33409OtherNATIONWIDE
OH9339121OtherMEDICARE GROUP NUMBER
OH2137557Medicaid
OH00063092OtherMEDICARE RAILROAD