Robert D. Carlson, M.D. , LLC
Organization Active NPI Family Medicine Physician · Stafford Springs, CT
NPI 1861718264 · NPPES record last updated Jan 11, 2013
Key facts
- NPI
- 1861718264
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ROBERT D. CARLSON, M.D. , LLC
- Practice address
- 47 E Main St
Stafford Springs, CT 06076-1227 - Phone
- (860) 684-5871
- Fax
- (860) 684-0469
- NPI assigned
- Apr 12, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. Robert D Carlson, M.D. , LLC, M.D.
- Title
- Owner/Member
- Phone
- (860) 429-8439
Practitioners 1
-
Robert D Carlson, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100909000507 | CT | Part B Supplier - Clinic/Group Practice | 5991820367 |
Receives reassigned benefits from 1 practitioner Practice locations: Stafford Springs, CT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
47 E Main St
Stafford Springs, CT 06076-1227
Mailing address
11 Phelps Way
Pob 399
Willington, CT 06279
Phone (860) 429-8439
Other providers in Stafford Springs, CT
- Rhianna Leigh Pluciennik
- Preferred Healthcare Associates Inc
- Tadeusz Rachwal
- Andrea Leduc Reid
- Rite-Aid Pharmacy
- Kara Nicole Schoedler
- Lauren Sembersky
- Crystal Shaw
- Deborah Shearer
- Desh R Sindwani
All providers in Stafford Springs, CT · Family Medicine Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.