Provider Demographics
NPI:1760441240
Name:NELSON, DAVID BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRIAN
Last Name:NELSON
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 1:410 S HERLONG AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-8349
Mailing Address - Country:US
Mailing Address - Phone:803-985-3937
Mailing Address - Fax:803-985-3922
Practice Address - Street 1:410 S HERLONG AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-8349
Practice Address - Country:US
Practice Address - Phone:803-985-3937
Practice Address - Fax:803-985-3922
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22281207W00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC22281OtherSC LICENSE
SC201017243OtherFEDERAL TAX ID
1437370657OtherGROUP NPI
SCGP4138Medicaid
SCH36794Medicare UPIN