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NPI Code Detail

MEDICARE: DR. MARK G NELSON M.D.

MEDICARE: DR. MARK G NELSON M.D.
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
1208600000XSurgery PhysicianD0056355MD
2208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianD0056355MD

General Provider Information

NPI Number : 1134111743
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK G NELSON M.D.
Provider Business Mailing Address
First Line : 12502 WILLOWBROOK RD
Second Line : SUITE 470
City : CUMBERLAND
State : MD
Zip : 21502-6393
Country : US
Telephone Number : 240-964-8724
Fax Number : 240-964-8735
Provider Business Practice Location Address
First Line : 12502 WILLOWBROOK RD
Second Line : SUITE 470
City : CUMBERLAND
State : MD
Zip : 21502-6393
Country : US
Telephone Number : 240-964-8724
Fax Number : 240-964-8735
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2005
Last Update Date : 02/24/2010

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