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General NPI Number Information
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NPI Number | 1700959632
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Entity Type | Individual
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Provider Name | SCOTT J CARLSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1721 TAUSSIG
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City | NORFOLK
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State | VA
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Zip | 23511
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Country | US
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Telephone | 757-953-8868
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Fax |
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Provider Business Mailing Address
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Address Line | 1454 DORY DR APT 1848
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City | VIRGINIA BEACH
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State | VA
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Zip | 23453-5651
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Country | US
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Telephone | 757-953-8868
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 01049196A
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License Number State | IN
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