Provider Demographics
NPI:1649322785
Name:NIERODA, CAROL ANN (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:NIERODA
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 1:10807 HAMPTON MILL TER
Mailing Address - Street 2:#130
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-5460
Mailing Address - Country:US
Mailing Address - Phone:301-231-7137
Mailing Address - Fax:
Practice Address - Street 1:7300 VAN DUSEN RD
Practice Address - Street 2:EMERGENCY ROOM
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-9463
Practice Address - Country:US
Practice Address - Phone:301-497-7954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD45784207PE0004X, 208600000X
OH35.054679207PE0004X
MDD0045784207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD854314Medicaid
MDF18591Medicare UPIN
MD189600800Medicare ID - Type Unspecified