Provider Demographics
NPI:1073539839
Name:NIELSEN, LOIS E (MD)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:E
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LOIS
Other - Middle Name:E
Other - Last Name:NEITZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 62026
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 SISTER PIERRE DR
Practice Address - Street 2:SUITE # 206
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7516
Practice Address - Country:US
Practice Address - Phone:410-296-3650
Practice Address - Fax:410-296-3641
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKF68/ 403096-01OtherBC/BS OF MD
MDS190 / 0002OtherBLUE CHOICE
MDS190 / 0002OtherBLUE CHOICE
MDKL28 / 08CCMedicare ID - Type Unspecified