Provider Demographics
NPI:1871881540
Name:NILSSON, LARS OLA (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:LARS OLA
Middle Name:
Last Name:NILSSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTER DRIVE MSC 1103
Mailing Address - Street 2:BLDG 10-CRC, ROOM 1-3330
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:301-451-0397
Mailing Address - Fax:301-480-3932
Practice Address - Street 1:10 CENTER DRIVE MSC 1103
Practice Address - Street 2:BLDG 10-CRC, ROOM 1-3330
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-451-0397
Practice Address - Fax:301-480-3932
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ5333794208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics