Provider Demographics
NPI:1013900174
Name:CARLSON, ROBERT D (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:CARLSON
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 1:47 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STAFFORD SPRINGS
Mailing Address - State:CT
Mailing Address - Zip Code:06076-1227
Mailing Address - Country:US
Mailing Address - Phone:860-684-5848
Mailing Address - Fax:
Practice Address - Street 1:47 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STAFFORD SPRINGS
Practice Address - State:CT
Practice Address - Zip Code:06076-1227
Practice Address - Country:US
Practice Address - Phone:860-684-5848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029923207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT61373363OtherUNITED HEALTH CARE
CT1299230Medicaid
CT0129923000OtherBLUE CARE FAMILY PLAN
CT010029923-CT01OtherBCBS
CT0R3605OtherHEALTH NET
CT4230366OtherAETNA
CTTOP027OtherOXFORD HEALTH PLAN
CT01029923OtherCIGNA
CT029923OtherCONNECTICARE
CT4230366OtherAETNA
CTE07203Medicare UPIN