Provider Demographics
NPI:1720085459
Name:NELSON, EDWARD I (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:I
Last Name:NELSON
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:PO BOX 638938
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8938
Mailing Address - Country:US
Mailing Address - Phone:937-619-3616
Mailing Address - Fax:937-949-4870
Practice Address - Street 1:7691 5 MILE RD STE 10
Practice Address - Street 2:SUITE 270
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4348
Practice Address - Country:US
Practice Address - Phone:937-619-3616
Practice Address - Fax:937-949-4870
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.092154207L00000X
KY34587207L00000X, 208VP0014X, 207L00000X
OH35-092154208VP0014X
OH35092154208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2889352Medicaid
OH4247852Medicare PIN
OH2889352Medicaid
OHH089213Medicare PIN
IL036100166Medicaid
OH2889352Medicaid