Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1256PT | MD |
NPI | 1154479707 |
---|---|
Provider Name | Dr. Spencer Howard Olson |
First Address | Edgewater, MD 21037-1700 |
Second Address | Edgewater, MD 21037-1700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T59593 | (02) | MD |