Individual
MARILYN MK NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1302 E MAIN ST, ENDICOTT, NY 13760-5430
(607) 754-2323
(607) 754-1846
Mailing address
33 LEWIS RD, 2ND FL, BINGHAMTON, NY 13905
(607) 729-8156
(607) 729-3982
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0065518
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0035061003
—
WV
05
—
1007288800
—
PA
05
—
482501200
—
MD
Enumeration date
07/21/2006
Last updated
02/18/2019
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