Provider Demographics
NPI:1821364928
Name:CARLSON, TODD DUANE (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:DUANE
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TODD
Other - Middle Name:DUAN
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5600 S QUEBEC STREET
Mailing Address - Street 2:SUITE 312A
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2208
Mailing Address - Country:US
Mailing Address - Phone:720-754-2296
Mailing Address - Fax:844-669-1725
Practice Address - Street 1:1719 E 19TH AVE
Practice Address - Street 2:IM HOSPITALIST
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1235
Practice Address - Country:US
Practice Address - Phone:720-754-2296
Practice Address - Fax:844-669-1725
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0055181207R00000X
CO555181208M00000X
390200000X
CO55181208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61486833Medicaid
CO428916YM4QMedicare PIN
CO61486833Medicaid