Provider Demographics
NPI:1548552995
Name:NELSON, ELIZABETH ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 RIDGE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1398
Mailing Address - Country:US
Mailing Address - Phone:732-274-2727
Mailing Address - Fax:
Practice Address - Street 1:395 RIDGE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1398
Practice Address - Country:US
Practice Address - Phone:732-274-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08738000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics