Provider Demographics
NPI:1174592653
Name:NIELSEN, GUNNLAUGUR PETUR (MD)
Entity type:Individual
Prefix:DR
First Name:GUNNLAUGUR
Middle Name:PETUR
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST WRN 2
Practice Address - Street 2:PATHOLOGY ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-1469
Practice Address - Fax:617-726-9312
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA78780207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3124584Medicaid
MAJ30551OtherBCBS MA
MA078780OtherTUFTS HEALTH PLAN
MA078780OtherTUFTS HEALTH PLAN
MAJ30551Medicare ID - Type Unspecified