Healthcare Provider Details

I. General information

NPI: 1356317010
Provider Name (Legal Business Name): MARYANN CARLSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARYANN CARLSON MD

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1459
COLUMBIA FALLS MT
59912-1459
US

IV. Provider business mailing address

PO BOX 31585
BILLINGS MT
59107-1585
US

V. Phone/Fax

Practice location:
  • Phone: 406-892-3208
  • Fax:
Mailing address:
  • Phone: 406-752-3239
  • Fax: 406-752-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4176
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4176
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: