Provider Demographics
NPI:1497711717
Name:CARLSON, KARL C JR (CP, BOCOP, CPT)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:C
Last Name:CARLSON
Suffix:JR
Gender:M
Credentials:CP, BOCOP, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0638
Mailing Address - Country:US
Mailing Address - Phone:910-391-3782
Mailing Address - Fax:252-535-0078
Practice Address - Street 1:725 HAMILTON STREET
Practice Address - Street 2:SUITE D
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-2746
Practice Address - Country:US
Practice Address - Phone:910-391-3782
Practice Address - Fax:252-535-0078
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC047C0OtherBLUE CROSS & BLUE SHIELD
NC7704534Medicaid
NC7704534Medicaid