Active NPI
Ernest James Nelson Jr., MD
- Pediatric Pathology Physician
- Philadelphia, PA
National Provider Identifier
1104352533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Pathology Physician
- License
- MT213676
- Practice address
- 3401 Civic Center Blvd
Philadelphia, PA 19104-4319 - Phone
- (215) 590-1728
- NPI assigned
- May 4, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Pathology Physician | 207ZP0213X | MT213676 | PA | Primary |
Addresses
Primary practice location
3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Mailing address
3601 Market St Unit 2903
Philadelphia, PA 19104-5943
Phone (229) 291-8471
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT213676 | PA | MD | Pediatric Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688515200000",
"number": "1104352533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3601 MARKET ST UNIT 2903",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191045943",
"telephone_number": "229-291-8471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 CIVIC CENTER BLVD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044319",
"telephone_number": "215-590-1728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "ERNEST",
"middle_name": "JAMES",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-05-04",
"last_updated": "2023-07-05",
"certification_date": "2023-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0213X",
"taxonomy_group": "",
"desc": "Pathology, Pediatric Pathology",
"state": "PA",
"license": "MT213676",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.