Provider Demographics
NPI:1578774865
Name:CERSONSKY, NANCY A (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:A
Last Name:CERSONSKY
Suffix:
Gender:F
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 218
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-0218
Mailing Address - Country:US
Mailing Address - Phone:866-317-3801
Mailing Address - Fax:512-583-2001
Practice Address - Street 1:5901 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2015
Practice Address - Country:US
Practice Address - Phone:057-736-7004
Practice Address - Fax:405-720-3910
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK288912085R0001X
OH570078662085R0001X
TXQ25242085R0001X
CO461112085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO021800OtherKAISER COMMERCIAL NUMBER
CO23484241Medicaid
OK200410900AMedicaid
OK200410900AMedicaid
CO23484241Medicaid