Provider Demographics
NPI:1487625786
Name:NELSON, SCOTT M (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:NELSON
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 1:9500 MENTOR AVE
Mailing Address - Street 2:#200
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8713
Mailing Address - Country:US
Mailing Address - Phone:440-352-1474
Mailing Address - Fax:440-352-2662
Practice Address - Street 1:9500 MENTOR AVE
Practice Address - Street 2:#200
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8713
Practice Address - Country:US
Practice Address - Phone:440-352-1474
Practice Address - Fax:440-352-2662
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-1360-N174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH04001184OtherTRAVELERS RAILROAD MEDICA
OH104634OtherKAISER
OH71359OtherQUALCHOICE
OH000000133451OtherANTHEM
OH0578101Medicaid
OH3415313198A11OtherBCBS
OH71359OtherQUALCHOICE
OH3415313198A11OtherBCBS