Nelson A Bonheim, MD
Individual provider Active NPI Gastroenterology Physician · Greenwich, CT
NPI 1366514549 · NPPES record last updated Sep 24, 2010
Key facts
- NPI
- 1366514549
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gastroenterology Physician 207RG0100X
- License
- 017080 (CT)
- Practice address
- 500 W Putnam Ave
Suite 100
Greenwich, CT 06830-6086 - Phone
- (203) 863-2900
- Fax
- (203) 863-2901
- NPI assigned
- Nov 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110622 | NY | MD | Social Worker |
| 017080 | CT | MD | Gastroenterology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 017080 | CT | Yes |
Addresses
Primary practice location
500 W Putnam Ave
Suite 100
Greenwich, CT 06830-6086
Mailing address
500 W Putnam Ave
Suite 100
Greenwich, CT 06830-6086
Phone (203) 863-2900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 017080 | Other | CT | COMMERCIAL |
| 1170802 | Medicaid | CT |
Other providers in Greenwich, CT
- Mieke Boggs
- Ann Monica Boisvert
- Steven Boksenbaum
- Joseph Raymond Boldt II
- Mary E Bolger
- James Stephen Borges
- Gregory Bottaro
- Jillian Bowes
- Donald Barry Boyd
- Joanie Garcia Bradshaw
All providers in Greenwich, CT · Gastroenterology Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.