Provider Demographics
NPI:1205021243
Name:OLSEN, LOUIS ODIN (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:ODIN
Last Name:OLSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FARNHAM WAY
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-7417
Mailing Address - Country:US
Mailing Address - Phone:410-252-5925
Mailing Address - Fax:
Practice Address - Street 1:7 FARNHAM WAY
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-7417
Practice Address - Country:US
Practice Address - Phone:410-252-5925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D75285Medicare UPIN