MEDICARE: INGRID CARLSON MD

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
1	207V00000X	Obstetrics & Gynecology Physician	016275	ME
2	207V00000X	Obstetrics & Gynecology Physician	47025	KY
3	207VG0400X	Gynecology Physician	62087	GA
4	207VG0400X	Gynecology Physician	2019016072	MO
5	207VG0400X	Gynecology Physician	ME112115	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME014001	OTHER	ME	MEDICARE TYPE UNSPECIFIED

General Provider Information

NPI Number	:	1841270824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID CARLSON MD

Provider Business Mailing Address
First Line	:	395 3RD ST
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-5231
Country	:	US
Telephone Number	:	904-466-2841
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 3RD ST
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-5231
Country	:	US
Telephone Number	:	904-466-2841
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	08/15/2019

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Directions to “ INGRID CARLSON MD” Practice Location

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