Provider Demographics
NPI:1568486983
Name:MALDONADO, NELSON A (MD)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:A
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 9TH ST N STE 202
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5625
Mailing Address - Country:US
Mailing Address - Phone:239-261-4866
Mailing Address - Fax:239-261-4839
Practice Address - Street 1:599 9TH ST N STE 202
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5625
Practice Address - Country:US
Practice Address - Phone:239-261-4866
Practice Address - Fax:239-261-4839
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064782207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376787600Medicaid
FL26370Medicare ID - Type Unspecified
F94585Medicare UPIN