Provider Demographics
NPI:1598886699
Name:NELSON, AVA WILLIAMS (MD)
Entity Type:Individual
Prefix:DR
First Name:AVA
Middle Name:WILLIAMS
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AVA
Other - Middle Name:
Other - Last Name:NELSON-NAPPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5409 JACKS CT
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3705
Mailing Address - Country:US
Mailing Address - Phone:410-788-2372
Mailing Address - Fax:
Practice Address - Street 1:5409 JACKS CT
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3705
Practice Address - Country:US
Practice Address - Phone:410-788-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0031653174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1334367Medicaid
MD1334367Medicaid
MDB70578Medicare UPIN