MEDICARE: MRS. SAMANTHA R CARLSON PA-C

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	363AM0700X	Medical Physician Assistant	0010-04129	NC

General Provider Information

NPI Number	:	1043595960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SAMANTHA R CARLSON PA-C

Provider Business Mailing Address
First Line	:	2020 WATERSCAPE WAY
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-7097
Country	:	US
Telephone Number	:	252-531-5301
Fax Number	:	252-531-5305

Provider Business Practice Location Address
First Line	:	2020 WATERSCAPE WAY
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-7097
Country	:	US
Telephone Number	:	252-531-5301
Fax Number	:

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

Provider Enumeration Date	:	10/12/2011
Last Update Date	:	08/07/2019

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