MEDICARE: MARYANN 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	208000000X	Pediatrics Physician	4176	MT
2	207Q00000X	Family Medicine Physician	4176	MT

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
2	0000095390	OTHER	MT	BCBS OB PHYS GRP

General Provider Information

NPI Number	:	1356317010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANN CARLSON MD

Provider Business Mailing Address
First Line	:	PO BOX 31585
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59107-1585
Country	:	US
Telephone Number	:	406-752-3239
Fax Number	:	406-752-3252

Provider Business Practice Location Address
First Line	:	PO BOX 1459
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-1459
Country	:	US
Telephone Number	:	406-892-3208
Fax Number	:

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	12/08/2017

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