Provider Demographics
NPI:1316995574
Name:CARLSON, ERIC JOHN (DO)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JOHN
Last Name:CARLSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:353 MEDICAL OFFICE BUILDING EAST
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-649-9021
Mailing Address - Fax:610-649-8058
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:353 MEDICAL OFFICE BUILDING EAST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-649-9021
Practice Address - Fax:610-649-8058
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011047L207VM0101X
NJ25MB06319700207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0184927006OtherAMERICHOICE
PA02640OtherHEALTH PARTNERS
PA1652891OtherBC/BS HIGHMARK GROUP
PA2330386000OtherBC/BS KEY, PER. GROUP
PA33658OtherHEALTH PARTNERS
PA3716959OtherAETNA US HEALTHCARE GROUP
PA00184927Medicaid
PA00866773000OtherBC/BS KEYSTONE, PERSONAL
PA33657OtherHEALTH PARTNERS
PA33659OtherHEALTH PARTNERS
PA3716982OtherAETNA US HEALTHCARE HMO
PA30018993OtherKEYSTONE MERCY
PA923742OtherBC/BS SHIELD HIGHMARK
PA30018989OtherKEYSTONE MERCY GROUP
PA5824670OtherAETNA US HEALTHCARE
PA33658OtherHEALTH PARTNERS
PA30018993OtherKEYSTONE MERCY