Provider Demographics
NPI:1730322900
Name:NIESSEN, TIMOTHY M (MD, MPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:NIESSEN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N WOLFE ST
Mailing Address - Street 2:NELSON 215
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0001
Mailing Address - Country:US
Mailing Address - Phone:443-287-4362
Mailing Address - Fax:410-502-0923
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:NELSON 215
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0001
Practice Address - Country:US
Practice Address - Phone:443-287-4362
Practice Address - Fax:410-502-0923
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0074245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine