Provider Demographics
NPI:1801981048
Name:CARLSON, DAVID R (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3023 HAMAKER CT
Mailing Address - Street 2:SUITE 210A
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2222
Mailing Address - Country:US
Mailing Address - Phone:703-698-8060
Mailing Address - Fax:703-876-4691
Practice Address - Street 1:3023 HAMAKER CT
Practice Address - Street 2:SUITE 210A
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2222
Practice Address - Country:US
Practice Address - Phone:703-698-8060
Practice Address - Fax:703-876-4691
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101016735207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101016735OtherSTATE LICENSE
VAD05846Medicare UPIN