Provider Demographics
NPI:1154581486
Name:NOTTINGHAM, LIESL KAYE (MD)
Entity type:Individual
Prefix:DR
First Name:LIESL
Middle Name:KAYE
Last Name:NOTTINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2415 MUSGROVE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5200
Mailing Address - Country:US
Mailing Address - Phone:301-989-2300
Mailing Address - Fax:301-236-5357
Practice Address - Street 1:2415 MUSGROVE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5200
Practice Address - Country:US
Practice Address - Phone:301-989-2300
Practice Address - Fax:301-236-5357
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063680174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology