Provider Demographics
NPI:1609827401
Name:CARLSON, LAWRENCE W III (CRNA)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:W
Last Name:CARLSON
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:LARRY
Other - Middle Name:W
Other - Last Name:CARLSON
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:# L-3652
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-6052
Mailing Address - Country:US
Mailing Address - Phone:740-383-7927
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:1050 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6416
Practice Address - Country:US
Practice Address - Phone:740-383-7778
Practice Address - Fax:740-375-8174
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN277926367500000X
OHCOA.04689-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2150872Medicaid
000000205999OtherANTHEM
430066223OtherMEDICARE RAILROAD
430066223OtherMEDICARE RAILROAD
OHH016783Medicare PIN