Provider Demographics
NPI:1427060805
Name:NESTLER, ELLEN OLARSCH (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:OLARSCH
Last Name:NESTLER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:131 COVENTRY ST
Mailing Address - Street 2:BURGDORF CLINIC 2ND FLOOR - ADMINISTRATION
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1548
Mailing Address - Country:US
Mailing Address - Phone:860-714-3690
Mailing Address - Fax:860-714-8683
Practice Address - Street 1:131 COVENTRY ST
Practice Address - Street 2:BURGDORF CLINIC 2ND FLOOR - ADMINISTRATION
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1548
Practice Address - Country:US
Practice Address - Phone:860-714-3690
Practice Address - Fax:860-714-8683
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT030865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001308651Medicaid
CTF35616Medicare UPIN