Provider Demographics
NPI:1003037763
Name:OLSON, NEIL (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 GLENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:STORRS MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06269-2011
Mailing Address - Country:US
Mailing Address - Phone:860-486-4700
Mailing Address - Fax:860-486-0004
Practice Address - Street 1:234 GLENBROOK RD
Practice Address - Street 2:
Practice Address - City:STORRS MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06269-2011
Practice Address - Country:US
Practice Address - Phone:860-486-4700
Practice Address - Fax:860-486-0004
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT16560207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
C59658OtherUPIN
1003037763OtherNPI
CT16560OtherSTATE LICENSE
440000189OtherMEDICARE NUMBER
440000189OtherMEDICARE NUMBER