Provider Demographics
NPI:1831490325
Name:MARSHA CRISCIO NELSON, MD, PA
Entity Type:Organization
Organization Name:MARSHA CRISCIO NELSON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:CRISCIO
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-974-2381
Mailing Address - Street 1:5959 GATEWAY BLVD W
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3331
Mailing Address - Country:US
Mailing Address - Phone:915-779-1716
Mailing Address - Fax:915-771-6496
Practice Address - Street 1:1700 N OREGON ST
Practice Address - Street 2:SUITE 620
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3584
Practice Address - Country:US
Practice Address - Phone:915-779-1716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6532208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty