Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | D0056355 | MD |
N | 208600000X | Surgeon | D0056355 | MD |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | D0056355 | MD |
NPI | 1134111743 |
---|---|
Provider Name | Dr. Mark G Nelson |
First Address | Cumberland, MD 21502-6393 |
Second Address | Cumberland, MD 21502-6393 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 24/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F43847 | (02) | MD |