Provider Demographics
NPI:1902860380
Name:NELSON, ROBERT T (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
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 1:9101 STONY POINT DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-330-9105
Mailing Address - Fax:804-287-6119
Practice Address - Street 1:9101 STONY POINT DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-330-9105
Practice Address - Fax:804-287-6119
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101 057617208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA340015802OtherRAILROAD MEDICARE
VA83639OtherSOUTHERN HEALTH
VA258452OtherALLIANCE
VA5380621OtherAETNA PPO
VA092950000-00OtherQUALCHOICE
VA21941OtherCIGNA
VA007502184Medicaid
VA230622668OtherTRICARE
VA44021OtherCARENET
VACA6752OtherRAILROAD MEDICARE GROUP #
VA1900405OtherUNITED HEALTHCARE
VA2081219OtherAETNA HMO
VA45731OtherSENTARA FAMILY CARE
VAV04385OtherMEDICARE GROUP #
VA5380621OtherAETNA PPO
VA007502184Medicaid
VAC04008Medicare UPIN
VAC04008Medicare UPIN