Provider Demographics
NPI:1003050154
Name:CARLSON, HANS T (MD)
Entity Type:Individual
Prefix:
First Name:HANS
Middle Name:T
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HALTON VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6825
Mailing Address - Country:US
Mailing Address - Phone:864-281-9440
Mailing Address - Fax:864-281-9443
Practice Address - Street 1:115 HALTON VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6825
Practice Address - Country:US
Practice Address - Phone:864-281-9440
Practice Address - Fax:864-281-9443
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC36780207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
36780OtherSTATE LICSENCE
SCSC3491Medicare PIN