Provider Demographics
NPI:1457320178
Name:NELSON, DAVID L (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:NELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MT. EUSTIS ROAD
Mailing Address - Street 2:AMMONOOSUC COMMUNITY HEALTH SERVICES, INC.
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-3712
Mailing Address - Country:US
Mailing Address - Phone:603-444-2464
Mailing Address - Fax:603-444-3441
Practice Address - Street 1:25 MT. EUSTIS ROAD
Practice Address - Street 2:AMMONOOSUC COMMUNITY HEALTH SERVICES, INC.
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-3712
Practice Address - Country:US
Practice Address - Phone:603-444-2464
Practice Address - Fax:603-444-3441
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30203035Medicaid
VT1009024Medicaid
NH30203035Medicaid
VT1009024Medicaid