Individual
DR. JASON RICHARD CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
328 YORK ST, CORRY, PA 16407-1413
(814) 663-3030
(814) 664-4105
Mailing address
1 LECOM PL, ERIE, PA 16505-2571
(814) 868-2522
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OS016768
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1028985940004
—
PA
Enumeration date
10/04/2012
Last updated
01/04/2017
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