Healthcare Provider Details

I. General information

NPI: 1326178500
Provider Name (Legal Business Name): PATRICIA LYNN CARLSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 N. CHARLES STREET SHEPPARD PRATT
TOWSON MD
21204
US

IV. Provider business mailing address

6501 N. CHARLES STREET SHEPPARD PRATT
TOWSON MD
21204
US

V. Phone/Fax

Practice location:
  • Phone: 410-938-5206
  • Fax: 410-938-4044
Mailing address:
  • Phone: 410-938-5206
  • Fax: 410-938-4044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0069755
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: