1770601106 NPI number — DR. NELSON STEPHEN DELGADO O.D.

Table of content: DR. NELSON STEPHEN DELGADO O.D. (NPI 1770601106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770601106 NPI number — DR. NELSON STEPHEN DELGADO O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELGADO
Provider First Name:
NELSON
Provider Middle Name:
STEPHEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DELGADO
Provider Other First Name:
N. STEPHEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1770601106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10300 LITTLE PATUXENT PKWY
Provider Second Line Business Mailing Address:
SUITE 1005-B
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21044-3341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-740-9952
Provider Business Mailing Address Fax Number:
410-740-9731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10300 LITTLE PATUXENT PKWY
Provider Second Line Business Practice Location Address:
SUITE 1005-B
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-3341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-740-9952
Provider Business Practice Location Address Fax Number:
410-740-9731
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  MD1273 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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