MEDICARE: DR. ARN ELIASSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	D0064342	MD
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	D0064342	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D0064342	OTHER	MD	MEDICAL LIC # MARYLAND

General Provider Information

NPI Number	:	1750391033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARN ELIASSON MD

Provider Business Mailing Address
First Line	:	PO BOX 6083
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-0083
Country	:	US
Telephone Number	:	410-465-8503
Fax Number	:	410-465-8503

Provider Business Practice Location Address
First Line	:	10290 BALTIMORE NATIONAL PIKE
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-3670
Country	:	US
Telephone Number	:	410-465-8503
Fax Number	:	410-465-8570

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	08/10/2016

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Directions to “ DR. ARN ELIASSON MD” Practice Location

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