Provider Demographics
NPI:1548224280
Name:NELSON, NAVEENA (MD)
Entity Type:Individual
Prefix:
First Name:NAVEENA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAVEENA
Other - Middle Name:
Other - Last Name:VALSARAJAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-853-4721
Mailing Address - Fax:513-852-8525
Practice Address - Street 1:375 DIXMYTH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-862-2573
Practice Address - Fax:513-852-8525
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083638207RG0300X
KYTP859207RG0300X
OH35-083638207RG0300X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH24444304Medicaid
IN200522490Medicaid
OH2444304Medicaid
KY64074297Medicaid
OH2444304Medicaid
IN200522490Medicaid
OHP00105232Medicare PIN
H46859Medicare UPIN