Provider Demographics
NPI:1326178500
Name:CARLSON, PATRICIA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6501 N. CHARLES STREET
Mailing Address - Street 2:SHEPPARD PRATT
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-938-5206
Mailing Address - Fax:410-938-4044
Practice Address - Street 1:6501 N. CHARLES STREET
Practice Address - Street 2:SHEPPARD PRATT
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-938-5206
Practice Address - Fax:410-938-4044
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00697552084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program