Healthcare Provider Details

I. General information

NPI: 1962515643
Provider Name (Legal Business Name): PAUL JEFFREY CARLSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11B FIRST FIELD RD
GAITHERSBURG MD
20878
US

IV. Provider business mailing address

6123 MONTROSE RD
ROCKVILLE MD
20852
US

V. Phone/Fax

Practice location:
  • Phone: 301-990-6880
  • Fax: 301-990-0257
Mailing address:
  • Phone: 301-881-3700
  • Fax: 301-468-1862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0062133
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: