Individual
IAN R NEILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
887 CONGRESS ST, SUITE 300, PORTLAND, ME 04102-3100
(207) 662-5555
(207) 662-5526
Mailing address
301 US ROUTE 1, SCARBOROUGH, ME 04074-7609
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
5423
AK
2086S0120X
Pediatric Surgery Physician
Primary
MD18028
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30208266
—
NH
05
—
433399099
—
ME
05
—
MD98332
—
AK
Enumeration date
10/16/2006
Last updated
11/26/2014
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