Provider Demographics
NPI:1891923199
Name:AWEH, NELSON KISOB (MD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:KISOB
Last Name:AWEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NELSON
Other - Middle Name:KISOB
Other - Last Name:AWEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:269 CARLISLE RD APT A
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1536
Mailing Address - Country:US
Mailing Address - Phone:617-642-0441
Mailing Address - Fax:617-642-0441
Practice Address - Street 1:255 GARDEN ST
Practice Address - Street 2:APT # 7
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1256
Practice Address - Country:US
Practice Address - Phone:617-642-0441
Practice Address - Fax:617-642-0441
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH19629207R00000X
MA240603207R00000X
MA253793208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist