Healthcare Provider Details

I. General information

NPI: 1720085459
Provider Name (Legal Business Name): EDWARD I NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7691 5 MILE RD STE 10 SUITE 270
CINCINNATI OH
45230-4348
US

IV. Provider business mailing address

PO BOX 638938
CINCINNATI OH
45263-8938
US

V. Phone/Fax

Practice location:
  • Phone: 937-619-3616
  • Fax: 937-949-4870
Mailing address:
  • Phone: 937-619-3616
  • Fax: 937-949-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.092154
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34587
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number34587
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number35-092154
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number35092154
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: