Provider Demographics
NPI:1134198674
Name:CARLSON, JOHN COMPTON (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:COMPTON
Last Name:CARLSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 SILVERSIDE RD
Mailing Address - Street 2:THE COMMONS, SUITE 33
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4929
Mailing Address - Country:US
Mailing Address - Phone:302-478-7973
Mailing Address - Fax:302-478-2746
Practice Address - Street 1:3524 SILVERSIDE RD
Practice Address - Street 2:THE COMMONS, SUITE 33
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4929
Practice Address - Country:US
Practice Address - Phone:302-478-7973
Practice Address - Fax:302-478-2746
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0000683207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000147904Medicaid
DE449528M71Medicare PIN
DE0000147904Medicaid