Martine Therese Nelson, MD

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

036067467 Issued in IL

Practice address

2745 Maple Ave
Lisle, IL 60532-3280

Phone

(630) 717-9600

Fax

(630) 717-5297

NPI assigned

Oct 11, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Martine Nelson, MD, LLC

  • Pediatric Adolescent Medicine Physician
  • Lisle, IL
  • NPI 1790967016
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222128000000",
    "number": "1669561478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2745 MAPLE AVE",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323280",
            "telephone_number": "630-717-9600",
            "fax_number": "630-717-5297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2745 MAPLE AVE",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323280",
            "telephone_number": "630-717-9600",
            "fax_number": "630-717-5297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "MARTINE",
        "middle_name": "THERESE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2008-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "IL",
            "license": "036067467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "31601930",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036067467",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nandria Healthcare LLC
• Naperville Psychological Associates LLC
• Naperville Radiologists
• National Clinical Labs
• Neeta F. Bhushan DDS PC
• Hussen Ngo
• Candis Nikolic, MSW
• NKS Dental P.C. (Lisle Family Dentistry)
• Ashley Christina Nolan, LMFT
• Brittany Norem, RD

• Pediatric Adolescent Medicine Physician in Lisle, IL
• Providers in Lisle, IL by specialty
• Pediatric Adolescent Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.