Provider Demographics
NPI:1790756575
Name:NELSON, MARTHA C (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:C
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 1:19650 CLUB HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMRY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3039
Mailing Address - Country:US
Mailing Address - Phone:301-948-5700
Mailing Address - Fax:240-683-3612
Practice Address - Street 1:19650 CLUB HOUSE RD
Practice Address - Street 2:
Practice Address - City:MONTGOMRY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-3039
Practice Address - Country:US
Practice Address - Phone:301-948-5700
Practice Address - Fax:240-683-3612
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD343562085R0202X
DCMD162532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD002173S37Medicare ID - Type Unspecified
MDE63873Medicare UPIN