Provider Demographics
NPI:1851352108
Name:NELSON, BOBBY W (MD)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:W
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 1:9200 FOREST HILL AVE
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6867
Mailing Address - Country:US
Mailing Address - Phone:804-323-3262
Mailing Address - Fax:804-330-3827
Practice Address - Street 1:9200 FOREST HILL AVE
Practice Address - Street 2:SUITE C-2
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-6867
Practice Address - Country:US
Practice Address - Phone:804-323-3262
Practice Address - Fax:804-330-3827
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010186722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7110413Medicaid
260002549Medicare ID - Type Unspecified
VA7110413Medicaid