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General NPI Number Information
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NPI Number | 1861718264
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Entity Type | Organization
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Legal Business Name | ROBERT D. CARLSON, M.D. , LLC
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 01/11/2013
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Provider Practice Location Address
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Address Line | 47 E MAIN ST
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City | STAFFORD SPRINGS
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State | CT
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Zip | 06076-1227
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Country | US
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Telephone | 860-684-5871
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Fax | 860-684-0469
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Provider Business Mailing Address
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Address Line | 11 PHELPS WAY POB 399
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City | WILLINGTON
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State | CT
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Zip | 06279
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Country | US
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Telephone | 860-429-8439
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Fax | 860-429-3145
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. ROBERT D CARLSON, M.D. , LLC
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Credential | M.D.
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Telephone | 860-429-8439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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