Basic Information
Provider Information | |||||||||
NPI: | 1407886831 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NELSON | ||||||||
FirstName: | EDWARD | ||||||||
MiddleName: | ARNOLD | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3421 CONCORD RD | ||||||||
Address2: |   | ||||||||
City: | YORK | ||||||||
State: | PA | ||||||||
PostalCode: | 174029001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7178511405 | ||||||||
FaxNumber: | 7178513535 | ||||||||
Practice Location | |||||||||
Address1: | 1001 S GEORGE ST BLDG MKB | ||||||||
Address2: |   | ||||||||
City: | YORK | ||||||||
State: | PA | ||||||||
PostalCode: | 174033676 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7178512521 | ||||||||
FaxNumber: | 7178513535 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/03/2006 | ||||||||
LastUpdateDate: | 02/26/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD022917E | PA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 542990 | 01 | MD | CAREFIRST MD BCBS | OTHER | 80781 | 01 | PA | UNISON-WMG | OTHER | 01060801 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 30153611 | 01 | PA | AMERIHEALTH CARITAS PA - WMG - THFPC | OTHER | 0010054000 | 01 | PA | AMERIHEALTH 65 PA | OTHER | 1142353 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 162698 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 35352 | 01 | PA | GEISINGER | OTHER | 30029 | 01 | PA | JOHNS HOPKINS | OTHER | 5451040 | 01 | PA | AETNA | OTHER | P002802 | 01 | PA | GATEWAY-WMG | OTHER | 000913465 | 05 | PA |   | MEDICAID | 233243 | 01 | PA | MAMSI-WMG | OTHER |