Provider Demographics
NPI:1063542736
Name:NELSON, MARSHA CRISCIO (MD)
Entity type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:CRISCIO
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 64367
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-0367
Mailing Address - Country:US
Mailing Address - Phone:910-829-6588
Mailing Address - Fax:910-829-6596
Practice Address - Street 1:1841 QUIET CV
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3985
Practice Address - Country:US
Practice Address - Phone:910-829-6588
Practice Address - Fax:910-829-6596
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC158306208600000X
TXN6532208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1063542736OtherVA CHOICE
NC1063542736Medicaid