Provider Demographics
NPI:1972696037
Name:NELSON, ROBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2201 RIDGEWOOD ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-6977
Mailing Address - Country:US
Mailing Address - Phone:610-378-9601
Mailing Address - Fax:610-378-3610
Practice Address - Street 1:2201 RIDGEWOOD ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-6977
Practice Address - Country:US
Practice Address - Phone:610-378-9601
Practice Address - Fax:610-378-3610
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422537101YP2500X, 2084P0800X
283Q00000X, 174400000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No283Q00000XHospitalsPsychiatric HospitalGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA73953Medicare PIN
PAH35122Medicare UPIN
PA073953XTGMedicare PIN