1821364928 NPI number — TODD DUANE CARLSON MD

Table of content: TODD DUANE CARLSON MD (NPI 1821364928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821364928 NPI number — TODD DUANE CARLSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARLSON
Provider First Name:
TODD
Provider Middle Name:
DUANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARLSON
Provider Other First Name:
TODD
Provider Other Middle Name:
DUAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1821364928
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5600 S QUEBEC STREET
Provider Second Line Business Mailing Address:
SUITE 312A
Provider Business Mailing Address City Name:
GREENWOOD VILLAGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80111-2208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-754-2296
Provider Business Mailing Address Fax Number:
844-669-1725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1719 E 19TH AVE
Provider Second Line Business Practice Location Address:
IM HOSPITALIST
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80218-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-754-2296
Provider Business Practice Location Address Fax Number:
844-669-1725
Provider Enumeration Date:
03/23/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  DR.0055181 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 555181 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 55181 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 61486833 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".