Individual
KEVIN E CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10700 CHARTER DR, STE 200, COLUMBIA, MD 21044-3629
(410) 910-7444
(410) 910-2310
Mailing address
10700 CHARTER DR, STE 200, COLUMBIA, MD 21044-3629
(410) 910-7444
(410) 910-2310
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0053636
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68747002
BC/BS OF MD
MD
05
—
769200500
—
MD
01
—
B6100006
BC/BS OF DC
DC
Enumeration date
09/06/2005
Last updated
01/31/2012
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