Healthcare Provider Details

I. General information

NPI: 1801978465
Provider Name (Legal Business Name): NANCY ELLEN PROSSER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 JOPPA FARM RD
JOPPA MD
21085-4463
US

IV. Provider business mailing address

742 JOPPA FARM RD
JOPPA MD
21085-4463
US

V. Phone/Fax

Practice location:
  • Phone: 410-679-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD31093
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: