Provider Demographics
NPI:1427013796
Name:ADELSON, ANTHONY B (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:B
Last Name:ADELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 ST FRANCIS WAY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4925
Mailing Address - Country:US
Mailing Address - Phone:765-446-4819
Mailing Address - Fax:756-446-4859
Practice Address - Street 1:9628 WEXFORD RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5751
Practice Address - Country:US
Practice Address - Phone:904-945-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE216222085R0202X, 2085R0204X
FLME653242085R0204X
IN01073672A208D00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078557572Medicaid
FL254903400Medicaid
FL001457800Medicaid
FL254903400OtherMEDICAID
FL00145780Medicaid
FL001457800Medicaid
F78248Medicare UPIN
NE47078557572Medicaid