Provider Demographics
NPI:1376035485
Name:CARLSON, NATASHA MOZUMDAR (MD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:MOZUMDAR
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 CHEW ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5549
Mailing Address - Country:US
Mailing Address - Phone:610-969-3500
Mailing Address - Fax:
Practice Address - Street 1:3794 HECKTOWN RD STE 250
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2355
Practice Address - Country:US
Practice Address - Phone:484-546-5800
Practice Address - Fax:484-544-0122
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT215792207Q00000X
PAMD474791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine