Provider Demographics
NPI:1952323461
Name:NELSON MEDICAL GROUP
Entity Type:Organization
Organization Name:NELSON MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-546-7049
Mailing Address - Street 1:255 S 17TH ST
Mailing Address - Street 2:SUITE 2001
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6231
Mailing Address - Country:US
Mailing Address - Phone:215-546-7049
Mailing Address - Fax:215-546-8646
Practice Address - Street 1:255 S 17TH ST
Practice Address - Street 2:SUITE 2001
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6231
Practice Address - Country:US
Practice Address - Phone:215-546-7049
Practice Address - Fax:215-546-8646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1912952789OtherNPI#
PAMD050257LOtherMEDICAL LICENCE
PAOS006039LOtherLICENSE #
PAMD051318LOtherLICENSE #
PAMD050204LOtherLISCENCE NUMBER
PAMD050257LOtherMEDICAL LISCENCE
PAMD013724EOtherMEDICAL LISCENCE
PAMD004666EOtherMEDICAL LISCENCE
PAMD033656LOtherLICENSE #
PAC31657OtherUPIN
PAMD004666EOtherMEDICAL LISCENCE
PAMD050204LOtherLISCENCE NUMBER
PAMD050257LOtherMEDICAL LISCENCE