Provider Demographics
NPI:1235196288
Name:CARLISLE, ERIC S (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:CARLISLE
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:PO BOX 60039
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-6039
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:16237 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2201
Practice Address - Country:US
Practice Address - Phone:818-995-5350
Practice Address - Fax:818-995-5032
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90140207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A901400Medicaid
I35374Medicare UPIN
CAWA90140BMedicare PIN
CA00A901400Medicaid
CAWA90140CMedicare PIN