Individual
ANNA ELISSA NIDECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
600 NORTH WOLFE ST, BALTIMORE, MD 21264-2307
(410) 933-1340
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
(410) 933-1340
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
D67430
MD
2085R0202X
Diagnostic Radiology Physician
MD600003312
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
418574900
—
MD
05
—
D0067430
—
MD
Enumeration date
02/29/2008
Last updated
10/18/2024
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