Provider Demographics
NPI:1245240753
Name:CARLSON, RIMA BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:RIMA
Middle Name:BETH
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-223-4738
Mailing Address - Fax:802-223-6067
Practice Address - Street 1:156 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2702
Practice Address - Country:US
Practice Address - Phone:802-223-4738
Practice Address - Fax:802-223-6067
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420012034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIRC081912OtherBLUE CROSS STATE ID
MI0C16002OtherMEDICARE GROUP
VT1017996Medicaid
MI104917201Medicaid
I58905Medicare UPIN
VT1017996Medicaid
MIRC081912OtherBLUE CROSS STATE ID