Provider Demographics
NPI:1205859667
Name:ELIASSON, ORN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ORN
Middle Name:
Last Name:ELIASSON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11711 FOXSPUR CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1515
Mailing Address - Country:US
Mailing Address - Phone:410-960-4899
Mailing Address - Fax:410-995-9052
Practice Address - Street 1:9106 PHILADELPHIA RD STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4333
Practice Address - Country:US
Practice Address - Phone:410-995-9052
Practice Address - Fax:410-995-9050
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0031076207R00000X, 207RC0200X, 2083P0500X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406471200Medicaid
MDK244S734Medicare PIN
MD406471200Medicaid