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:
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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 1:8100 SANDPIPER CIR STE 210
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4992
Practice Address - Country:US
Practice Address - Phone:855-527-7246
Practice Address - Fax:866-229-5063
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-17
Last Update Date:2024-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DCDO33153207L00000X
MDH0058012207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699474101Medicaid