Provider Demographics
NPI:1902812027
Name:CARLSON, BETH LUANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:LUANNE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 THORN RUN RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2861
Mailing Address - Country:US
Mailing Address - Phone:412-299-8400
Mailing Address - Fax:
Practice Address - Street 1:935 THORN RUN RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2861
Practice Address - Country:US
Practice Address - Phone:412-299-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003087L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant