Provider Demographics
NPI:1346351749
Name:CARLSON, BETH L (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:L
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:LOREN
Other - Last Name:WHITMARSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 679B
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-341-9370
Mailing Address - Fax:585-273-1129
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-341-9370
Practice Address - Fax:585-273-1129
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010023363AS0400X
NY10023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA0809Medicare ID - Type Unspecified
NYQ41827Medicare UPIN