Provider Demographics
NPI:1780890806
Name:NELSON, AMY ROBBINS BOWERING (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ROBBINS BOWERING
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:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:
Practice Address - Street 1:401 N 11TH STREET
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23291-5037
Practice Address - Country:US
Practice Address - Phone:804-828-4409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101265819207V00000X
TXN3937207V00000X
CT050378207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020644850001Medicaid
PA196113OtherHIGHMARK BLUE SHIELD ASSIGNMENT ACCOUNT #
PA1020644850001Medicaid
PA123283Medicare PIN