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Individual
MARYANN CARLSON
Active
Individual
MARYANN CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4176
MT
208000000X
Pediatrics Physician
4176
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000095390
BCBS OB PHYS GRP
MT
05
—
0102782
—
MT
Enumeration date
02/23/2006
Last updated
12/08/2017
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