Provider Demographics
NPI:1124073887
Name:CARLISLE, AMANDA SUE (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUE
Last Name:CARLISLE
Suffix:
Gender:F
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:PO BOX 7464
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94120-7464
Mailing Address - Country:US
Mailing Address - Phone:415-206-8509
Mailing Address - Fax:415-285-2037
Practice Address - Street 1:1001 POTRERO AVENUE
Practice Address - Street 2:RM 2A21
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:415-206-8509
Practice Address - Fax:415-285-2037
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48329207L00000X, 207LC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA810000759OtherRAILROAD MEDICARE
CA00G483290Medicaid
CA00G483290Medicare ID - Type Unspecified
E98746Medicare UPIN