Provider Demographics
NPI:1104087063
Name:CARLISLE, MATTHEW C (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:CARLISLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2315 STOCKTON BLVD
Mailing Address - Street 2:PSSB 2100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2201
Mailing Address - Country:US
Mailing Address - Phone:916-734-8249
Mailing Address - Fax:916-734-7950
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:PSSB 2100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-8249
Practice Address - Fax:916-734-7950
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2011-08-03
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Provider Licenses
StateLicense IDTaxonomies
SCLL30921207P00000X
CA267865207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine