Provider Demographics
NPI:1306011135
Name:NELSON, LORI ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ELIZABETH
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 IRVING ST NW
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2921
Mailing Address - Country:US
Mailing Address - Phone:202-877-1621
Mailing Address - Fax:202-829-2632
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:SUITE 600
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1809
Practice Address - Country:US
Practice Address - Phone:301-581-8030
Practice Address - Fax:301-581-8031
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD751162081P2900X
VA01012494802081P2900X
PAMD4352202081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102397704-0001Medicaid
PA102397704-0001Medicaid