Provider Demographics
NPI:1922107523
Name:CARLSEN, RAY A (MD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:A
Last Name:CARLSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 130TH AVE NE STE 201
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1756
Mailing Address - Country:US
Mailing Address - Phone:425-455-9945
Mailing Address - Fax:425-455-9947
Practice Address - Street 1:2330 130TH AVE NE STE 201
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1756
Practice Address - Country:US
Practice Address - Phone:425-455-9945
Practice Address - Fax:425-455-9947
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00012169207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1061845Medicaid
WA1061845Medicaid
AB12790Medicare ID - Type Unspecified