Provider Demographics
NPI:1255331989
Name:NEILSON, ROBERT N (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:NEILSON
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 1:1590 MEDICAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3247
Mailing Address - Country:US
Mailing Address - Phone:610-327-7673
Mailing Address - Fax:
Practice Address - Street 1:1590 MEDICAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3247
Practice Address - Country:US
Practice Address - Phone:610-327-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039497E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B42283Medicare UPIN