MEDICARE: DR. NANCY A CERSONSKY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	28891	OK
2	2085R0001X	Radiation Oncology Physician	57007866	OH
3	2085R0001X	Radiation Oncology Physician	Q2524	TX
4	2085R0001X	Radiation Oncology Physician	46111	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	021800	OTHER	CO	KAISER COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578774865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY A CERSONSKY MD

Provider Business Mailing Address
First Line	:	PO BOX 218
Second Line	:
City	:	LOWELL
State	:	AR
Zip	:	72745-0218
Country	:	US
Telephone Number	:	866-317-3801
Fax Number	:	512-583-2001

Provider Business Practice Location Address
First Line	:	5901 W MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-2015
Country	:	US
Telephone Number	:	57-736-7004
Fax Number	:	405-720-3910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	03/02/2020

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