Provider Demographics
NPI:1962515643
Name:CARLSON, PAUL JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JEFFREY
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 1:6123 MONTROSE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-881-3700
Mailing Address - Fax:301-468-1862
Practice Address - Street 1:11B FIRST FIELD RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878
Practice Address - Country:US
Practice Address - Phone:301-990-6880
Practice Address - Fax:301-990-0257
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00621332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406643000Medicaid
DCA2840143OtherBCBS OF DC
MD7363711OtherAETNA
MD64401001OtherBCBS OF MD
MD784453000OtherMAGELLAN
MD247377OtherKAISER
MD784453000OtherMAGELLAN