Provider Demographics
NPI:1558894923
Name:NELSON, CLARKE STORROW (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CLARKE
Middle Name:STORROW
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-3416
Mailing Address - Country:US
Mailing Address - Phone:410-752-1677
Mailing Address - Fax:410-752-4435
Practice Address - Street 1:100 PARK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3416
Practice Address - Country:US
Practice Address - Phone:410-752-1677
Practice Address - Fax:410-752-4435
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0091534207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology