Provider Demographics
NPI:1134111743
Name:NELSON, MARK G (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:G
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12502 WILLOWBROOK RD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6393
Mailing Address - Country:US
Mailing Address - Phone:240-964-8724
Mailing Address - Fax:240-964-8735
Practice Address - Street 1:12502 WILLOWBROOK RD
Practice Address - Street 2:SUITE 470
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6393
Practice Address - Country:US
Practice Address - Phone:240-964-8724
Practice Address - Fax:240-964-8735
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2010-02-24
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Provider Licenses
StateLicense IDTaxonomies
MDD0056355208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF43847Medicare UPIN