Provider Demographics
NPI:1073505632
Name:CARSON, THOMAS H (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:CARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:718 RIDGELAKE DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-4229
Mailing Address - Country:US
Mailing Address - Phone:504-831-7029
Mailing Address - Fax:504-828-4209
Practice Address - Street 1:200 HENRY CLAY AVE
Practice Address - Street 2:CHILDREN'S HOSPITAL- DEPARTMENT OF PATHOLOGY
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5720
Practice Address - Country:US
Practice Address - Phone:504-896-9816
Practice Address - Fax:504-894-5354
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5331R207ZB0001X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1364771Medicaid
B63982Medicare UPIN
52600Medicare ID - Type Unspecified