Provider Demographics
NPI:1720155336
Name:ADAMSON, NELSON L (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:L
Last Name:ADAMSON
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 1:1900 CENTRACARE CIRCLE
Mailing Address - Street 2:CENTRACARE CLINIC HEALTH PLAZA SPECIALTIES
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-229-4901
Mailing Address - Fax:
Practice Address - Street 1:1013 HART BLVD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8575
Practice Address - Country:US
Practice Address - Phone:763-295-2945
Practice Address - Fax:763-271-2283
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010772722085R0001X
MN1040232085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4302627Medicaid
MI320220107OtherBCBS
MI920006245OtherRAILROAD MEDICARE
MI920006245OtherRAILROAD MEDICARE
C60747Medicare UPIN