Provider Demographics
NPI:1710943121
Name:CARLSON, JOHN A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:CARLSON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:7000 ATRIUM WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MOUNT LAUEL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-291-6818
Mailing Address - Fax:856-291-6819
Practice Address - Street 1:200 BOWMAN DRIVE
Practice Address - Street 2:SUITE E315
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-247-7310
Practice Address - Fax:856-247-7309
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2014-04-11
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Provider Licenses
StateLicense IDTaxonomies
NJMA55574207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5508100Medicaid
NJ489984B3LMedicare ID - Type Unspecified
NJ5508100Medicaid