Provider Demographics
NPI:1710985882
Name:NELKEN, ROBERT PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PETER
Last Name:NELKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HAVERHILL ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1504
Mailing Address - Country:US
Mailing Address - Phone:978-475-4522
Mailing Address - Fax:978-475-6531
Practice Address - Street 1:140 HAVERHILL ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1504
Practice Address - Country:US
Practice Address - Phone:978-475-4522
Practice Address - Fax:978-475-6531
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45786208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0107662Medicaid
E03045Medicare UPIN
D02061Medicare ID - Type Unspecified