Healthcare Provider Details

I. General information

NPI: 1679625495
Provider Name (Legal Business Name): AMANDA CARLSON NORTH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA CARLSON NORTH M.D.

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST MARBURG 143
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

16 BROADWAY
DOBBS FERRY NY
10522-2804
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-2914
  • Fax:
Mailing address:
  • Phone: 914-478-8252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number231921
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: