MEDICARE: MELISSA E CARLSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	ME73434	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023017803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA E CARLSON MD

Provider Business Mailing Address
First Line	:	770 NORTHPOINT PARKWAY
Second Line	:	SUITE 102
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407
Country	:	US
Telephone Number	:	561-275-7604
Fax Number	:	561-802-5385

Provider Business Practice Location Address
First Line	:	1447 MEDICAL PARK BLVD
Second Line	:	SUITE 300
City	:	WELLINGTON
State	:	FL
Zip	:	33414-3164
Country	:	US
Telephone Number	:	561-790-5990
Fax Number	:	561-790-5952

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	09/25/2017

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