Provider Demographics
NPI:1285697508
Name:CARLSON, ELAINE (MD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HEALTHCARE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9449
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-282-9180
Practice Address - Street 1:72 MAIN ST
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7021
Practice Address - Country:US
Practice Address - Phone:207-467-8909
Practice Address - Fax:207-467-8910
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015356207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEC90481OtherHARVARD PILGRIM
ME038778OtherANTHEM
MEM183518OtherCIGNA
ME2337286OtherAETNA
ME288040099Medicaid
MEMM836601Medicare PIN
MEC90481OtherHARVARD PILGRIM
MEM183518OtherCIGNA