Provider Demographics
NPI:1710045554
Name:CARSON T. LO MD PA
Entity type:Organization
Organization Name:CARSON T. LO MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARSON
Authorized Official - Middle Name:TAN
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-599-3222
Mailing Address - Street 1:PO BOX 19814
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77224-9814
Mailing Address - Country:US
Mailing Address - Phone:281-599-3222
Mailing Address - Fax:
Practice Address - Street 1:1331 W GRAND PARKWAY N
Practice Address - Street 2:SUITE 310
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2735
Practice Address - Country:US
Practice Address - Phone:281-599-3222
Practice Address - Fax:281-599-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0112207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00399UMedicare PIN