Healthcare Provider Details

I. General information

NPI: 1225422793
Provider Name (Legal Business Name): LUCAS C. CARLSON MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 10/02/2021
Certification Date: 10/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

201 E UNIVERSITY PKWY
BALTIMORE MD
21218-2829
US

V. Phone/Fax

Practice location:
  • Phone: 857-307-0864
  • Fax: 617-394-3209
Mailing address:
  • Phone: 410-554-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number274809
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: