Provider Demographics
NPI:1104971555
Name:NELSON, CHRISTOPHER STANLEY (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:STANLEY
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTOPHER
Other - Middle Name:STANLEY
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9615 DEWITT DR APT 207
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-7106
Mailing Address - Country:US
Mailing Address - Phone:914-826-7344
Mailing Address - Fax:
Practice Address - Street 1:9615 DEWITT DR APT 207
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-7106
Practice Address - Country:US
Practice Address - Phone:914-826-7344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1878512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02174936Medicaid