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NPI Code Detail

MEDICARE: PETER CARLSON

MEDICARE: PETER CARLSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-09-5772MD

General Provider Information

NPI Number : 1295062735
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER CARLSON
Provider Business Mailing Address
First Line : 137 KENTUCKY AVE
Second Line :
City : PASADENA
State : MD
Zip : 21122-5400
Country : US
Telephone Number : 443-791-2645
Fax Number :
Provider Business Practice Location Address
First Line : 137 KENTUCKY AVE
Second Line :
City : PASADENA
State : MD
Zip : 21122-5400
Country : US
Telephone Number : 443-791-2645
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2009
Last Update Date : 11/04/2009

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Directions to “ PETER CARLSON ” Practice Location

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