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 1:1701 S CREASY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4972
Practice Address - Country:US
Practice Address - Phone:765-502-4000
Practice Address - Fax:765-446-4859
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE216222085R0202X, 2085R0204X
FLME653242085R0204X
IN01073672A2085R0202X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00145780Medicaid
NE47078557572Medicaid
FL254903400OtherMEDICAID
FL001457800Medicaid
FL254903400Medicaid
FL001457800Medicaid
F78248Medicare UPIN
NE47078557572Medicaid