Provider Demographics
NPI:1316945678
Name:NELSON, LOIS A (MD)
Entity type:Individual
Prefix:DR
First Name:LOIS
Middle Name:A
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3454 OAK ALLEY CT
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1370
Mailing Address - Country:US
Mailing Address - Phone:419-536-1322
Mailing Address - Fax:419-536-0302
Practice Address - Street 1:3454 OAK ALLEY CT STE 202
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1370
Practice Address - Country:US
Practice Address - Phone:419-536-1322
Practice Address - Fax:419-251-7715
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045307207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0435130Medicaid
OHNE4010976Medicare PIN
OH0435130Medicaid
C02176Medicare UPIN
OH0435130Medicaid
C02176Medicare UPIN