Provider Demographics
NPI:1427069186
Name:CARLSON, TIMOTHY DON (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DON
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3717 NATIONAL DR STE 130
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4830
Mailing Address - Country:US
Mailing Address - Phone:919-571-7444
Mailing Address - Fax:919-571-2721
Practice Address - Street 1:3717 NATIONAL DR STE 130
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4830
Practice Address - Country:US
Practice Address - Phone:919-571-7444
Practice Address - Fax:919-571-2721
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC268022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8921121Medicaid
C81592Medicare UPIN
NC8921121Medicaid