Healthcare Provider Details

I. General information

NPI: 1649512542
Provider Name (Legal Business Name): TRACY MARSH CARLSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY MICHELLE CARLSON

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ENCINO PL NE
ALBUQUERQUE NM
87102-2612
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-1312
  • Fax: 505-272-2240
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2013-0347
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2016-0616
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: