Provider Demographics
NPI:1811006802
Name:CARLSON, ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:240 INDIAN RIVER RD
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3649
Mailing Address - Country:US
Mailing Address - Phone:203-795-4924
Mailing Address - Fax:203-799-1554
Practice Address - Street 1:240 INDIAN RIVER RD
Practice Address - Street 2:SUITE B-1
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3649
Practice Address - Country:US
Practice Address - Phone:203-795-4924
Practice Address - Fax:203-799-1554
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT039862208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT01457RMedicare UPIN