Provider Demographics
NPI:1972589398
Name:NILSEN, STEPHEN M (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:NILSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:28665 EARTHLITE RD
Mailing Address - Street 2:
Mailing Address - City:WYE MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21679-2024
Mailing Address - Country:US
Mailing Address - Phone:410-827-7188
Mailing Address - Fax:410-827-7076
Practice Address - Street 1:28665 EARTHLITE RD
Practice Address - Street 2:
Practice Address - City:WYE MILLS
Practice Address - State:MD
Practice Address - Zip Code:21679-2024
Practice Address - Country:US
Practice Address - Phone:410-827-7188
Practice Address - Fax:410-827-7076
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0058012207L00000X
DCDO33153207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01897Medicare ID - Type Unspecified