Provider Demographics
NPI:1356338818
Name:CARLSON, KARA L (MD)
Entity type:Individual
Prefix:DR
First Name:KARA
Middle Name:L
Last Name:CARLSON
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 1:19020 33RD AVE W
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4746
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4746
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1374
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000362872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA122226OtherLNI PROVIDER ID
WA8227332Medicaid
WA175557OtherLNI PROVIDER ID
WAG8807537Medicare PIN
WAG54857Medicare UPIN
WAGAB39945Medicare PIN
WAGAB04341Medicare PIN
WAP300085569Medicare PIN
WAG8857964Medicare PIN
WA8227332Medicaid
WAGAB04241Medicare PIN
WAP00853452Medicare PIN
WAP300122253Medicare PIN