MEDICARE: DR. EDWARD I NELSON 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	207L00000X	Anesthesiology Physician	35.092154	OH
2	207L00000X	Anesthesiology Physician	34587	KY
3	208VP0014X	Interventional Pain Medicine Physician	34587	KY
4	208VP0014X	Interventional Pain Medicine Physician	35-092154	OH
5	208VP0000X	Pain Medicine Physician	35092154	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720085459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD I NELSON MD

Provider Business Mailing Address
First Line	:	PO BOX 638938
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-8938
Country	:	US
Telephone Number	:	937-619-3616
Fax Number	:	937-949-4870

Provider Business Practice Location Address
First Line	:	7691 5 MILE RD STE 10
Second Line	:	SUITE 270
City	:	CINCINNATI
State	:	OH
Zip	:	45230-4348
Country	:	US
Telephone Number	:	937-619-3616
Fax Number	:	937-949-4870

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/08/2017

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Directions to “ DR. EDWARD I NELSON MD” Practice Location

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