Provider Demographics
NPI:1316039993
Name:CARLSON, DAVID ADELBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ADELBERT
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 1:255 BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-1105
Mailing Address - Country:US
Mailing Address - Phone:203-562-5579
Mailing Address - Fax:203-458-7157
Practice Address - Street 1:255 BRADLEY ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-1105
Practice Address - Country:US
Practice Address - Phone:203-562-5579
Practice Address - Fax:203-458-7157
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0104672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry