Nelson R. De Lara, M.D.
Individual provider Active NPI Vascular & Interventional Radiology Physician · Phoenix, MD
NPI 1629242425 · NPPES record last updated Apr 14, 2008
Key facts
- NPI
- 1629242425
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Vascular & Interventional Radiology Physician 2085R0204X
- License
- D16268 (MD)
- Practice address
- 26 Glen Alpine Rd
Phoenix, MD 21131-2404 - Phone
- (410) 510-7017
- NPI assigned
- Apr 14, 2008
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D16268 | MD | MD | Vascular & Interventional Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Radiology P a | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular & Interventional Radiology Physician | 2085R0204X | D16268 | MD | Yes |
Addresses
Primary practice location
26 Glen Alpine Rd
Phoenix, MD 21131-2404
Mailing address
26 Glen Alpine Rd
Phoenix, MD 21131-2404
Phone (410) 510-7017
Other providers in Phoenix, MD
- Abigael Ciociola
- Catherine Cox
- Laura Marie Cox
- Alfred Franklin D'Anca
- Shilpa Das
- Bhavina Desai
- Michael F Diffendall
- Dr Alan R Scharf DDS LLC
- Dr. Maria Yiassemides, P.a.
- Joan Patricia Edwards
All providers in Phoenix, MD · Vascular & Interventional Radiology Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.