Provider Demographics
NPI:1477596138
Name:NADELSON, CRAIG S (DO)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:S
Last Name:NADELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-6264
Mailing Address - Country:US
Mailing Address - Phone:812-748-3412
Mailing Address - Fax:812-748-3413
Practice Address - Street 1:806 JACKSON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201
Practice Address - Country:US
Practice Address - Phone:812-748-3412
Practice Address - Fax:812-748-3413
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002977A207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200964810Medicaid
IN000000641129OtherANTHEM
I49554Medicare UPIN
IN000000641129OtherANTHEM
712430FMedicare ID - Type Unspecified
IN177280B9Medicare PIN