Provider Demographics
NPI:1083603427
Name:NELSON, RHONDA (DPM)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12150 ANNAPOLIS ROAD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9183
Mailing Address - Country:US
Mailing Address - Phone:301-773-1199
Mailing Address - Fax:301-773-1198
Practice Address - Street 1:12150 ANNAPOLIS ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9183
Practice Address - Country:US
Practice Address - Phone:301-773-1199
Practice Address - Fax:301-773-1198
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01318213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD134103100Medicaid
MDP00380750OtherPALMETTO GBA -RAILROAD MEDICARE
DCU70951Medicare UPIN
MD5394560001Medicare NSC
DCG01410P01Medicare PIN