Provider Demographics
NPI:1457334252
Name:CARSTENS, MARY CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE
Last Name:CARSTENS
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 1:4111 S DARLINGTON AVE
Mailing Address - Street 2:STE 700
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6348
Mailing Address - Country:US
Mailing Address - Phone:918-743-8838
Mailing Address - Fax:918-743-9058
Practice Address - Street 1:4111 S DARLINGTON AVE
Practice Address - Street 2:STE 700
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6348
Practice Address - Country:US
Practice Address - Phone:918-743-8838
Practice Address - Fax:918-743-9058
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK201682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100221220CMedicaid
OK300129678OtherRAILROAD MEDICARE
OK300074307OtherRAILROAD MEDICARE
OK300129678OtherRAILROAD MEDICARE
OKF78522Medicare UPIN
OKRADICT124Medicare ID - Type Unspecified