Basic Information
| Provider Information | |||||||||
| NPI: | 1457320178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 MT. EUSTIS ROAD | ||||||||
| Address2: | AMMONOOSUC COMMUNITY HEALTH SERVICES, INC. | ||||||||
| City: | LITTLETON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035613712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034442464 | ||||||||
| FaxNumber: | 6034443441 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 MT. EUSTIS ROAD | ||||||||
| Address2: | AMMONOOSUC COMMUNITY HEALTH SERVICES, INC. | ||||||||
| City: | LITTLETON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035613712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034442464 | ||||||||
| FaxNumber: | 6034443441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 02/11/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 11637 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30203035 | 05 | NH | MEDICAID | 1009024 | 05 | VT | MEDICAID |