Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 200401406 | NC |
NPI | 1417931460 |
---|---|
Provider Name | Karl H Karlson JR. |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 21/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10195471 | (05) | VA |
138CC | BCBS (01) | NC |
4590143 | AETNA (01) | |
805129 | PARTNERS (01) | NC |
89138CC | (05) | NC |
908940 | (05) | SC |
9840655000 | (05) | WV |
B90258 | (02) | |
D8313 | MEDCOST (01) | NC |