Provider Demographics
NPI:1811036825
Name:CARLSON, ANDREW P (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:P
Last Name:CARLSON
Suffix:
Gender:M
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:PO BOX 749112
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 RAY C HUNT DR STE 3100
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2980
Practice Address - Country:US
Practice Address - Phone:434-924-2203
Practice Address - Fax:434-244-4419
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113481207T00000X
VA0101281701207T00000X
NMMD2011-0265207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14MH4OtherBLUE CROSS BLUE SHIELD
FL006523200Medicaid
FL14MH4OtherBLUE CROSS BLUE SHIELD