Healthcare Provider Details

I. General information

NPI: 1457943607
Provider Name (Legal Business Name): MARCUS CARLSSON MD PHD ASSOC PROF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NATIONAL INSTITUTES OF HEALTH 10 CENTER DR RM 2C713
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

6311 HERKOS CT
BETHESDA MD
20817-3344
US

V. Phone/Fax

Practice location:
  • Phone: 240-255-8613
  • Fax:
Mailing address:
  • Phone: 202-560-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License NumberMD048555
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: