Individual
EBONY NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6031 LIBERTY RD, GWYNN OAK, MD 21207-6206
(443) 297-9171
Mailing address
3914 SUSANNA RD, RANDALLSTOWN, MD 21133-4056
(443) 297-9171
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
408932
MD
Other
Enumeration date
11/01/2018
Last updated
11/01/2018
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