Provider Demographics
NPI:1467408351
Name:NYQUIST, PAUL ALAN (MD, MPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ALAN
Last Name:NYQUIST
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 1:9910 FRANKLIN SQUARE DR STE 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-933-1390
Practice Address - Street 1:600 N WOLFE ST STE 455
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:410-955-6121
Practice Address - Fax:410-614-7903
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD55305207LC0200X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406264700Medicaid
MDKR78JHMedicare ID - Type UnspecifiedGROUP
MDK139Medicare ID - Type UnspecifiedINDIVIDUAL
MDKR37JHMedicare ID - Type UnspecifiedGROUP
MDL556Medicare ID - Type UnspecifiedINDIVIDUAL