Provider Demographics
NPI:1881834992
Name:NELSON, LISA J (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
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 1:2330 MAPUTO PL
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20189-2330
Mailing Address - Country:US
Mailing Address - Phone:404-775-1685
Mailing Address - Fax:
Practice Address - Street 1:2330 MAPUTO PL
Practice Address - Street 2:
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20189-2330
Practice Address - Country:US
Practice Address - Phone:404-775-1685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2056222080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases